By JESSE ABISHECK firstname.lastname@example.org
On September 25, 2023, the government formally launched a new initiative to integrate Community Health Promoters (CHP’s) into the health system to replace Community Health Volunteers (CHV’s). A month later on October 20th, 2023 President William Ruto signed into law the UHC bill, marking the commencement of a challenging journey to provide universal access to high-quality healthcare services.
The government pledged to employ 100,000 community health promoters, currently stationed in various counties, each serving 100 households. This move aims to bring healthcare services closer to citizens, reducing the need for lengthy journeys to access healthcare facilities. But some counties like Uasin Gishu haven’t engaged the CHP’S.
In a chilly village of labuywa in the slopes of Nandi hills, Nandi county, I meet Peter Lagat, a community health volunteer with seven years of experience in this service. Our day starts with a cup of tea and snacks. We then embark on a trip to Tinderet village, about over 40 kilometers from Peter’s home.
Peter explains what made him sacrifice to serve the community. “Due to lack of a job I decided to join community health volunteers to help people living around these villages back in 2013 under the Catholic Medical Mission Board (CMMB) since they believe in a world in which every human life is valued, where we were given a token to communicate with clients as we did registration house to house.” Being the head of his group Peter ensured they developed a relationship with communities through chief’s barazas, churches, going house to house, village elders and nyumba kumi. This improved their rapport with the clients”.
Peter has since developed a passion for his job. “It’s great working as a community health worker since I’m able to impact positively on the community where I collect data house to house, and there is indeed a good rapport from the people we attend to since most of the people we have attended to are responding well showing positive side of our work as community health volunteers something I’m proud of.”
Today Peter is visiting Jane Boit who is a 65year old grandmother suffering from diabetes. Her grandchild is taking care of her because of her condition. Despite their needs, they welcome us with a cup of porridge and some sweet potatoes. The family lives in a muddy house without electricity that depends on traditional lamps that generate smoke. Jane suspected she’s diabetic in 2019 but had no funds to attend hospital. “In 2022 I was referred by Peter to Kapsabet hospital where my left leg was amputated and now I use this artificial limb and this happened after disposing of a piece of my land since I couldn’t afford to pay for the treatment” she said. Ever since the community health Volunteer has been attending to me to monitor my response which I really appreciate.
“I have a challenge in terms of food since my situation doesn’t allow me to do anything, I depend on my daughter to help me since I don’t have anyone on my side my husband died ten years ago. So I only depend on my daughter for food though she does manual jobs in this village” Jane says.
Peter refers his clients to a nearby dispensary where Elvis Tum is a nurse. He works in Tachasis mission dispensary hand in hand with the community health volunteers. “When dealing with low lifestyle people the hospital uptake is low since most of them go for manual jobs and live from hand to mouth.” He says the CHVs go closer to the patients and convince them the importance of getting their medication from the hospitals.
Nurse Elvis stresses on the importance of early diagnosis of diseases such as TB and HIV. “We give drugs for those diseases free and collaborate with the CHV’s in educating the public on importance of having a balanced diet from the locally available foods” he explains.
On the matter of how that advocate for patient needs Elvis tells “we ensure that every staff are there on duty anytime, drugs are available so that when one walk in here they will not leave without treatment since this is the only nearby dispensary that serves big population. Also in a matter of assessing needs of particular community and developing program to address them most of the time we have defaulters who when given drugs thy don’t follow up we do visit them and establish what could be the problem of them not taking all the drugs on how we write them, from there now aske the community volunteers to jump in and trace the person.”
On a positive note Elvis says they educate people who face malnutrition in the village because of eating one type of food and they also do deworming in schools, churches, and in chiefs barazas.
Peter explain challenges he faces while on duty “we have a lot of challenges we undergo like poor state of states, harsh climate like sun or rainy seasons, low payment or late payments making some of us drop this job and venture to other things income generating activities to survive” he laments. The distance from one home to another on Nandi hills where snakes can attack them or the sick patients to the hospital. Even motorbikes cannot ferry clients in the hilly terrain.
AMREF Health Africa initiated a project involving Community Health Volunteers (CHV’s). Dr. Githinji Gitahi is the Global Chief Executive Officer of Amref Health Africa. According to him, the main difference in qualifications between Amref and CHV’s lies in the organizational structure. Dr. Githinji says “AMREF Health Africa being a health-focused NGO, typically requires professional qualifications in healthcare, while CHVs often have community-based training and may not possess formal medical degrees.”
AMREF Health CHV’s strategy has shown success in various African countries, including Kenya, Tanzania, and Uganda. The effectiveness may vary depending on the specific healthcare needs, community dynamics, and existing infrastructure in each country.
Community Health Units for Universal Health Coverage (CHU4UHC) is a partnership between various development partners working in the community health sphere. Despite the pivotal role played by CHP’s in Kenya, the sector encounters numerous challenges. Not all counties achieve 100% CHP coverage, and in instances of absolute coverage, not all CHPs undergo training or receive remuneration. This is according to CHU4UHC.
Some counties such as Uasin Gishu are yet to role out the services while some parts of Nandi county don’t enjoy the services. Incomplete coverage leaves certain communities without access to basic health services. As Peter laments in Nandi County, the absence of compensation for CHPs contributes to elevated turnover rates and burnout, as many struggle to balance volunteer work with income-generating pursuits. CHU4UHC observes that Insufficient training and supervision pose significant hurdles, as many CHPs lack the requisite skills and knowledge for effective healthcare provision. Retention remains an issue, with CHPs departing the sector due to burnout, lack of support, or inadequate remuneration. Additionally, sub-optimal supervision may lead to errors in healthcare service provision.