Regular training of community volunteers key in attaining UHC

Kenya’s community health strategy aims at providing basic prevention and care services. At the heart of this strategy are Community Health Volunteer (CHV) programmes that are key to robust health systems.

According to available data, CHV programmes can lead to a citizenry that is more engaged in care decisions and reduce the financial burden on care within the health sector. CHVs share health promotion messages, monitor chronic health conditions and treat common ailments and illnesses. 

They also refer community members to hospitals, participate in local health events, and establish protocols for community-based maternal and Newborn Health.

Significantly, the community approach has been recognised as an effective way for making improvements in healthcare delivery and CHVs are a key pillar of this approach. The devolution of healthcare placed county governments at the centre of service delivery.

But the important role played by CHVs became even more prominent at the height of the Covid-19 pandemic. As part of Kenya’s Covid-19 response strategy, CHVs were recognised as potential agents of behaviour change. 

They were to support the government to ensure that correct information reaches households, demystify myths and misconceptions, and support in health promotion by demonstrating good hygiene practices such as hand washing. They also played a vital role in active case-finding and contact tracing.

According to a study published in Oxford Academic, the journal of health policy and planning, CHVs are often considered as interposed between communities and the formal health system. They are seen as a means to ‘reach the last mile’ when implementing programmes, removing barriers to healthcare.

Preventable deaths

Given the crucial role played by CHVs, the government has officially placed them as the first level of the health system geared towards the attainment of the health goals articulated in Vision 2030. Globally, with renewed concern for universal health coverage (UHC) in the era of the SDGs, the role of CHVs in lower and middle-income countries seems under-explored.

There is evidence of a reduction in under – five mortality globally from 91 deaths/1000 live births in 1990 to 43/1000 (53 per cent reduction) in 2015, sub–Saharan Africa countries still continue to experience the highest under–five mortality rate, despite a 54 per cent decline from 180/1000 in 1990 to 83/1000 in 2015.

These deaths were largely preventable by means of countries adopting low cost, high impact interventions and effective delivery strategies such as those articulated in the iCCM national and global strategies.

The Oxford findings suggest that CHVs can make a greater contribution to extending coverage, especially to disadvantaged population groups in lower and middle-income countries, where there is a critical shortage of health professionals.

However, this demands careful thought by policymakers and health managers. For CHVs to be successful, they must be adequately resourced, with supportive supervision and mentoring, in-service training and adequate logistical support.

According to the Oxford study, in-service training, financial incentives, infrastructural support and supplies, appropriate monitoring, regular supportive supervision and evaluation, and integration of CHV programmes into the formal healthcare system were found to be facilitators of success. 

The study found that CHVs with adequate training, support and supervision, and a monetary/material allowance could increase uptake of anti-retroviral therapy in home visits. The study noted that task shifting from health professionals to CHVs ‘can potentially reduce cost of ART provision without compromising health outcomes’ in the patients.

Promoting health

On the other hand, lack of regular supervision, limited training, lack of clear definition of roles, too many vertical programmes and insufficient resources were key barriers to success of volunteer-led health programmes.

A report, Strategies to strengthen community health provision through CHVs in the Asal by Healthright International and inSupplyHealth states that training and supervision, highly motivating activities for CHV, are core elements of the community health strategy and are the responsibility of county governments. 

In practice, however, financial and technical support for training and supervision are often partner driven and inconsistent. In order to be an effective motivator, training needs to be consistently offered to all CHVs, not only a few, and must take into consideration literacy and language barriers. 

In addition, supportive supervision is considered critical and motivational. However, it is challenging to execute well due to budgetary and human resource constraints.

In summary, CHVs continue to play a significant role in promoting health, despite the lack of proper engagement structures with government and non -governmental entities. To ensure they are a highly motivated workforce for continuity in community service delivery, CHVs should be facilitated and empowered to meet their basic needs, trained and skilled to offer quality services, supported through supervision and mentorship, and recognized and appreciated for their work.

Community members and health system actors should be reintroduced to the roles and responsibilities of a CHV, so that their work can be aligned with the voluntary nature of the role and reduce the pressure or unrealistic expectations. Resource mobilisation structures are needed as are deliberate efforts for building CHV competence in delivery of services.

The writer is the Cluster Head- Novartis East Africa Cluster