“Kenya and Sub-Saharan Africa can afford health but not health care,” Dr. Githinji Gitahi, Group Chief Executive Officer (GCEO), Amref Health Africa states. This is because, with the current economic realities, most lower and middle-income countries invest significantly less on healthcare per capita (less than US $ 50) compared to developed countries particularly the G7 Counties whose investment exceeds US $ 4,000 on healthcare per person per year.
This necessitates investments in preventive, and promotive health as compared to curative-based health care. However, most countries have not yet embraced this because health provision has always been dependent on models developed by higher-income countries.
Kenya, however, has taken a bold step in changing the health system from a curative to preventive with investments in Primary Health Care including Community Health. It has been proven that investing in primary health care yields an ROI of 1:16 and investing in Community Health gives you a return on investment of 1:9.4.
It has not been easy! Kenya’s pursuit of Universal Health Coverage (UHC) has faced several challenges underlined by a growing population, emerging healthcare needs including communicable diseases, non-communicable diseases (NCDs), pandemics and a relatively low quantum of overall government spending on health and reducing international funding for health.
Community Health Services revamped
To deliver the gains highlighted in countries embracing community-based community health services, Kenya took a bold step through the Bottom-Up Economic Transformation Agenda (BETA) to invest in community health services. We applaud the Kenyan Government for scaling the CHU4UHC catalytic interventions countrywide.
The government fully professionalized over 100,000 Community Health Promoters (CHPs) by providing them with regular remuneration, smartphones for digitization and comprehensive CHP Kits containing NCD screening equipment (Blood Pressure Machine, Glucometer & Glucometer strips, weighing scales), MUAC tapes to check for malnutrition, water treatment commodities, comprehensive first aid kit among others. Moreover, to galvanize and sustain the interventions, the Kenyan Government in 2023 enacted the Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act, and Social Health Insurance Act to legislate the universal health coverage implementation.
The gains could not be tracked or realized without having a digital tool that supports service delivery, performance management, and reporting. That was the birth of the electronic community health information system (eCHIS). The tool was developed by the Ministry of Health with support from our technology partners Medic and Living Goods majorly with financial support from Global Fund through Amref Health Africa.
The tool was then deployed countrywide by CHU4UHC partners such as Amref Health Africa with 20 Counties, Lwala Community Alliance who piloted the eCHIS platform in Migori, Enai Africa who supported Kajiado County, Unicef who supported Nairobi, and Living Goods with 3 Counties. Moreover, through the CHU4UHC convening and donor coordination, other partners in the country majorly with support from USAID East Africa were able to support the national scale-up to achieve the 42 counties that are currently live on the Afya Nyumbani Dashboard.
The journey has been remarkable! We can now at the click of a button track the health status of over half of the Country’s population since the CHPs have already assessed the health status of over 5.77 Million Households. Indicators such as Non-communicable diseases, malaria, pneumonia, diarrhea, and high-risk pregnancies are assessed at household levels and managed with support from primary health facilities at the community level or link facilities.
To ensure the population is healthy, the community health promoters conduct health education, support health promotion and disease prevention using different models and tools such as water treatment chemicals, provision of condoms, mosquito nets distribution, and in some places family planning commodities as Community-Based Distributors.
Remarkably, CHPs are at the forefront at the time being in mitigating the effects of flooding in the country. They are assessing the risk status of households and access to health facilities in addition to being the first line of response where households are displaced or affected by flooding.
To emphasize the importance of the work the community health promoters are doing in the country, you just have to check the number of people screened for diabetes and hypertension which are silent killers of our population. To date, as reported through eCHIS, the CHPs in Kenya have screened 3.12 million people for diabetes and 2.26 million people for hypertension while referring over 56,600 and over 135,000 people for management of diabetes and hypertension respectively. With primary health care networks’ multi-disciplinary team (MDT) support to the community health units and primary health care facilities, the health outcomes of these referred cases are bound to be better.
Roadmap for Community Health Including eCHIS
With this progress, the MoH Division of Community Health has developed a roadmap to ensure the eCHIS system is sustained and enhanced with the implementing partners. This roadmap defines the resource requirements in addition to the support required for the next 3 years.
In the short term, through the Nanyuki Declaration in February 2024, all the 47 counties and Community Health Partners agreed to:
- Deploy all kits, smartphones and medicines/supplies to CHPs by 29th February 2024
- Training of CHPs on e-CHIS should be completed by 31st March 2024
- All 47 counties should be live on the Afya Nyumbani dashboard by 31st March 2024
- Counties to utilize link health facilities and local partners to train CHPs on the use of Kits by 29th February 2024
- Counties to deploy full-time health care workers – CHAs, CHOs, and other health professionals to supervise each community health unit by 31st March 2024
- National and County Governments to facilitate payment of CHP stipends as per the Intergovernmental Participation Agreements on PHC
Way forward
The CHU4UHC will continue supporting the Kenyan government and the community health program collaboratively through supporting the finalization and deployment of the Community Health promoter integrated curriculum, supporting performance management of Community Health Promoters, strengthening the supply chain management in the country, and continuous community engagement to ensure all people embrace community health services. In addition, the CHU4UHC commits to continue enhancing and improving the performance of the eCHIS System at the community and national levels to deliver population health outcomes.