Community health services, among other primary health care (PHC) services, are the fastest way to achieve universal health coverage (UHC). However, quality primary community-based primary health care provision has for ages in Kenya been hampered by systemic deficiencies, including community health promoter (CHP) capacity, kitting, remuneration and digitization. Moreover, community performance management has been a challenge due to Community Health Assistant (CHA) capacity, digitization and linkage to the formal health system.
It is against this backdrop that, over the past year, the government of Kenya, following the declaration by President Ruto in April 2023 on the shift from curative health to preventive and promotive has implemented transformational initiatives to enhance the quality of community health services dubbed Afya Nyumbani.
These services, delivered by CHPs, ensure that every citizen receives quality healthcare, particularly those in remote and underserved areas. CHPs are powering Afya Nyumbani! To support this change, the government has equipped all 100,000 CHPs with essential kits, provided smartphones to enhance their reporting and service delivery capabilities and started paying stipends to CHPs nationwide.
What challenges exist in community health?
Despite these advancements, challenges remain. In January 2024, the Division of Community Health identified several gaps:
Data from the community health registry and the confirmed lists of CHPs from the counties show that there is a gap of 28,000 CHPs who are not trained on the basic modules and on average, 60% of the CHPs are not trained on the comprehensive technical modules.
However, with the changes in the country’s health epidemiology, equipping of CHPs and social determinants of health, the community health promoter curriculum also required revision or development. The previous curriculum was developed in 2011, making it outdated considering the shifts in the CHP’s current job description.
Moreover, there is a challenge with CHP supervision and mentorship with some of the Community Health Officers (CHOs) who have not been trained on the CHP curriculum. This made it a challenge for the CHOs to effectively conduct performance management of CHPs since some CHPs were more empowered on community health.
Supply chain for community health commodities and equipment was also noted as a major concern for most counties. There was a minimal training for CHPs and their supervisors on community supply chain management leading to bottlenecks in forecasting, ordering, receiving, disposing and inventory management.
Progress in addressing the challenges
To ensure uniformity in training, the Ministry of Health with support from Amref Health Africa and Unicef, started reviewing the community health workers occupational standards, career progression guidelines and certification guidelines for community health workers. These documents are key in professionalizing the community health promoters in the country and aligning with the newly enacted Primary Health Care Act among other UHC laws enacted in 2023.
Secondly, guided by the policy documents developed, the Ministry of Health, with support from CHU4UHC and other development partners such as CDC and USAID, is developing or revising the CHP curriculum. The new curriculum will be digitized for eLearning to ensure the country reaches all the community health promoters at a minimal cost.
Thirdly, Amref Health Africa, with support from The Global Fund, is conducting a phased training program for CHAs and CHPs using the newly developed basic curriculum for CHPs. This training will be done in three phases, from June to September, across all counties, starting with 16 counties. The new curriculum covers the following modules:
- Module 1: Health and Development
- Module 2: Governance and Leadership
- Module 3: Advocacy, Communication and Community Engagement
- Module 4: Health Promotion
- Module 5: Disease Prevention
- Module 6: Basic Health Services
- Module 7: Community Health Information and Surveillance
- Module 8: Community Health Commodity Management
During the training in Wajir, Amref Health Africa spoke with Mohamed Adan Abdullahi, a CHA in charge of Malikafu Community Health Unit. A CHA since 2011, Mohamed is driven by the desire to improve his community’s health. He supports CHPs in conducting monthly dialogue days, reporting, and referring cases that need advanced attention. Mohamed emphasized the importance of the recent training, noting it was the first refresher since his initial training.
“We haven’t had such training after the initial training once we became CHAs. This refresher is timely because it will help me as I go out next week to train my CHPs. The gap in training for most CHPs really impacts the services they provide and the reports they submit. Adequate training for CHPs is crucial in their service delivery and reporting.” Mohamed stated.
training in Wajir County
Mohamed added “In Wajir, we face several challenges, including high illiteracy levels among CHPs, semi-nomadic communities, poor reporting, lack of transport to sparsely located units, and inadequate communication networks. This training will improve key health indicators such as non-communicable disease screening using the new CHP Kit, antenatal care (ANC), immunization, and postnatal care (PNC) among others.”
Adow Abdullahi Mohamed, the Sub-County Community Health Focal Person for Eldas Sub-County, echoed Mohamed’s sentiments. He stressed the importance of training and capacity building for CHAs, stating that it is crucial for improving the quality of reports and services provided.
“This training will greatly improve our indicators and the quality of community health services provided. Training and capacity building of CHAs isn’t greatly considered as that of CHPs, but it is important that even they, as supervisors, improve services holistically. Training CHAs will also improve the quality of reports received.” Adow retaliated.
Amref’s Commitment
Beyond the training of over 11,000 CHPs in basic modules and finalizing the technical modules, Amref Health Africa remains committed to enhancing the quality of community health services in Kenya, aligning with its strategic plan to deliver primary healthcare to communities. The organization continues to support the government’s BETA agenda to improve health service delivery across the nation.