In October 2023, as conversations around primary health in Kenya heightened, community health was recognized as a key prerequisite towards the achievement of Universal Health Coverage in Kenya. Following the launch of the community health program and distribution of Community Health Promoters (CHP) kits nationwide, CHU4UHC, in collaboration with the Division of Community Health, recognized and awarded the best-performing community health units in the country.

A community health unit is recognized as the basic health service delivery structure within a defined geographic area, covering a population of approximately 5,000 people. It is served by CHPs, who are supervised by a Community Health Assistant (CHA). CHPs act as the link between community members and the health system, providing preventive and promotive health services.

Nestled in Kwale County, Kenya, lies the Mwaroni Community Health Unit (CHU), a beacon of excellence in community health in 2023. In a ceremony presided over by CS Susan Nakhumicha, Mwaroni was recognized as the best-performing CHU in Kwale County. CHU4UHC engaged several Mwaroni CHU CHPs for a closer look into their outstanding performance.

Champions at the forefront

Mwaroni’s success is linked to CHP’s proactiveness and dedication. While Kwale County grappled with low COVID-19 vaccination rates, Mwaroni CHU wasn’t content with waiting. They meticulously mapped interventions, starting with vaccinating all their CHPs. Recognizing the influence of male elders, they piloted a community dialogue in Nngori village, led by male CHPs, specifically targeting unvaccinated elderly men. This success fueled further action. Male CHPs became champions, mobilizing the community for door-to-door vaccination campaigns and closely monitoring implementation alongside other CHPs.

This strategic approach extended to faithfully adhering to the national criteria for best practices in CUs developed by the Division of Community Health: regular reporting from their dedicated CHPs, monthly action days, quarterly dialogue days, and innovations in the CHU propelled Mwaroni to the top.

An unwavering passion for service 

Meet Binti Mwahaga, the lead CHP at Mwaroni CHU. Vibrant and vocal, Binti exudes this passion as she narrates how dedication and love for the community from her fellow CHPs fueled their operations and ultimately emerged as the best-performing CHU in the county. “Every CHP member in Mwaroni has passion and is committed to the cause. Our love for our community’s well-being and the thirst to see our community healthy are the driving forces behind our work as CHPs,” she notes. 

Mwaroni CHU’s journey began in the early 2000s, starting as a ‘chama cha wazee’ group. Its founding members were respected elder people in the community who were chosen to offer assistance and counsel in community matters. Recognizing the health disparities among the community members, the group morphed to offer voluntary health education to community members. In 2006 after the introduction of community health services in Kenya, Binti and her counterparts emerged as natural leaders chosen by members of Mwaroni, Gombato and Mvumoni villages to become community health workers (CHWs).  

“When we began, we were known as CHWs. At the time, there were prevalent cases of malaria in many rural areas, rampant due to a lack of awareness. Following sensitization from health facilities, we called for barazas to educate people on the prevention of malaria through the proper use of mosquito nets and proper waste disposal. We then visited households to ensure that household members had proper drainage systems to combat breeding areas for mosquitoes. We also informed them of the importance of clearing bushes around their homes and sleeping under treated mosquito nets, which greatly reduced the incidence of disease in our community.”

From unsung heroes to recognized partners 

For Iman Keya, who started as a Community Health Volunteer (CHV) in 2006, the award wasn’t just a trophy but a long-overdue validation for her CHU and other CHPs nationwide. “The award was a whispered ‘thank you’ for all the toil we have endured. I felt seen and my dedication mattered.”

CHPs have been the invincible backbone of community health and have witnessed firsthand the neglect of community health volunteers. For decades, CHPs in Kenya have served as unsung heroes, tirelessly delivering primary healthcare services in rural and underserved communities. They often operated with limited resources and minimal formal recognition, with their contributions frequently going unnoticed and undervalued.

“The biggest change I have witnessed in my community is the improved maternal mortality health indicators. We conduct visits to households with expectant mothers and sensitize them on the importance of attending at least four Antenatal Clinic (ANC) visits and safe hospital deliveries. We also follow up after delivery with a Post-natal care (PNC) visit to monitor the health of the mother and baby and educate on breastfeeding.” Iman adds. 

Equipping for the future: CHP kits and digitization 

Speaking to CHU4UHC during the electronic community health information system (eCHIS) training, Mohammed Athuman expressed his gratitude for the presidential decree changing their names from CHV to CHP and the provision of CHP kits and smartphones for reporting.  

“I no longer have to carry heavy books when conducting household visits. Everything I require is on this phone. I thank Amref Health Africa for conducting this training that will equip us with the necessary digital skills to help in our reporting.  In addition to the phone, I feel empowered by the CHP kit provided with equipment and drugs. I now have everything I need to do my job.” Mohammed noted. 

Advocacy for a well-remunerated, digitized, and institutionalized community health workforce continues to be a priority for a healthier, empowered nation.CHU4UHC recognizes the importance of a well-equipped and motivated community health workforce. CHU4UHC will continue its efforts to advocate for fair remuneration, digitization, and institutionalization, striving for a future where every CHP feels valued and empowered. 

Mwaroni CHU’s story is not just about accolades; it’s about a community united by a passion for health and a commitment to making a difference. Their journey serves as an inspiration, proving that dedication and a little support can lead to remarkable achievements, one household visit at a time.