How a coalition of partners in Kenya is supporting government efforts in deploying primary healthcare and community health

Kenya is on the journey to achieving Universal Health Coverage (UHC). The government has identified Primary Healthcare (PHC), including Community Health, as the pathway to achieving UHC. One of the five priorities in the President’s Bottom Up Economic Transformation Agenda (BETA) is health, with a focus on: a) Primary Healthcare; b) Health Insurance Coverage; c) Health Systems Capacity; and d) Health Data Systems.

A comprehensive and robust strategy is critical for the deployment of Kenya’s Primary Healthcare System in service of these goals. The Community Health Units for Universal Health Coverage (CHU4UHC) is a collaborative platform of community health-centric organisations in Kenya. This platform seeks to support the government’s efforts in deploying primary healthcare and community health.

The platform has enabled these organisations to collaborate on a single strategy and target resources toward a shared objective of advancing the professionalization of Community Health Promoters (CHPs) into the healthcare system and ensuring Afya Nyumbani – the delivery of high-quality community health services to all households in Kenya.

A global movement to professionalise community health workers, who despite offering critical primary health services, are not always adequately equipped, compensated, or integrated into the formal health workforce, is in motion.

In Kenya, critical steps are being made to change the narrative. There is a renewed commitment to professionalize CHPs. The CHU4UHC platform has been at the forefront of these efforts. We have partnered with the Ministry of Health to create an enabling environment and policies that advance the professionalization of CHPs.

Tremendous changes are happening to position CHPs as the centerpiece of this health transformation for Kenya. Key among these are presidential commitments to equip, digitise, and pay CHPs. Already, the President flagged off CHP kits on September 25, 2023, while national digitisation of CHPs is underway. In addition, critical Bills such as the Primary Healthcare Bill are in Parliament for adoption.

As CHU4UHC, we are proud of these efforts, which are a culmination of years of hard work with the Ministry of Health and county governments. CHU4UHC has developed policies and strategies that laid the foundation for what we are realising today. For decades, community health promoters used paper registers to track households, thereby compromising the quality of care they provided. Today, the Electronic Community Health Information System (eCHIS), a new digital platform, is being used by CHPs to advance UHC.

The Digital Journey

CHU4UHC coalition partnered with the Ministry of Health to develop the National Community Health Digitisation Strategy 2020. This strategy provided guidance on the necessary digital technology and infrastructure set-up, digital health human resources skills-set, data-driven performance management, essential commodities for service delivery, capacity building, mentorship and coaching, and sustainable financing, including CHP compensation and community health legislation. It also envisioned the identification and enhancement of a nationally scaled eCHIS integrated with the broader eHealth ecosystem.

Through the expertise of platform partners in digital health such as Living Goods and Medic, the Electronic Community Health Information System (eCHIS) was born. Partners such as Amref Health Africa, Lwala Community Alliance, Living Goods, and Enai Africa, among others with expertise in on-the-ground community health services delivery, contributed to the design and testing in a human-centred way. Today, we have an application that features a data-driven task list, real-time performance dashboard, and automated reporting into the Kenya Health Information System (KHIS), thereby enhancing the efficiency of CHPs as they deliver services at home. eCHIS is powering Afya Nyumbani.

Presently, eCHIS, powered by Community Health Toolkit, is being rolled out in several counties with the goal of digitising 100,000 CHPs nationally as committed by the President. The pilots in Kisumu and Migori counties provided the platform for the current national roll-out, which CHU4UHC continues to support.

Well-supported CHPs must be paid, trained, well-equipped, and supervised

The national roll-out of eCHIS is part of a much bigger plan to professionalize CHPs in Kenya. For the goals of Afya Nyumbani to be realised, CHPs must be paid, trained, supervised, and supplied.

CHU4UHC has worked hand in hand with the Ministry of Health and county governments to put in place legislation and policies to advance these professionalization goals.  Through the support of platform members, several counties have put in place Community Health Services Acts, while many others are on course to enacting their Bills.

More critically, Parliament is considering a Primary Health Care Bill, which will, among other things, provide for the creation of a Primary Healthcare Fund. This Fund will go a long way in ensuring that primary healthcare services, including community health, are adequately funded. This legislation, in addition to Certification Guidelines for CHPs and the CHW registry, will go a long way in ensuring that funding is made available for the payment of CHPs. In the interim, the President and county governments have reaffirmed their commitment to paying CHPs nationally through a cost-sharing arrangement.  

Training and supervision

As a platform, CHU4UHC recognises that digitisation, equipment, and payment are the first steps to well-performing CHPs. The performance will further depend on adequate training and supervision. Currently, there are huge gaps in CHP knowledge and training. In the past, training has been truncated and dependent on partner priorities, and this has made CHP skills and competencies vary across the country. We need to close this gap.

Building and enhancing the capabilities of CHPs will require a comprehensive training programme in a language and format CHPs can easily understand. There is a need to review the training curriculum and delivery, and build digital tools that enhance CHP learning. In addition, gaps in supervision should be filled. Presently, the country has only 3,250 Community Health Officers, against the projected need of 10,000. Effective supervision and mentorship that include peer-to-peer and 360-degree supervision, will go a long way in improving the quality of services delivered by CHPs. 

Financing Afya Nyumbani

Realising UHC/Afya Nyumbani requires substantial investments. CHU4UHC will continue to work with the Ministry of Health and counties to develop strategies for sustainable financing of community health and primary health care. Innovative financing mechanisms have been proposed by the platform, which if adopted, including the Facilities Improvement Financing (FIF) Bill in Parliament, will ensure that healthcare is delivered to every home.

As a coalition, even as we aim for greater domestic financing of health, we shall continue to advocate for investment in community health with global financing bodies such as The Global Fund, the World Bank, and other development partners. 

Our commitment

Delighted by the ongoing efforts to professionalize CHPs, it is critical that this momentum be sustained. We must be prepared to address and nimbly respond to challenges that will emerge in technology, training, personnel, data, and analytics, in order to assure sustainability. As a platform, we renew our commitment to partner with the Ministry of Health and county governments to advance primary healthcare and achieve UHC in Kenya.  

Our coalition

We are a platform of organisations committed to the professionalization of CHPs in Kenya. We work in partnership with the Ministry of Health, County Governments, Johnson & Johnson, ELMA Philanthropies, and other development partners to strengthen the delivery of high-quality primary health services, including community health, and advancing universal health coverage. Our core members are:

Amref Health Africa (Amref) is an independent non-profit, non-governmental organisation founded in 1957. It has grown to be the largest Africa-based non-profit healthcare organisation, serving millions, including disadvantaged people in sub-Saharan Africa. Headquartered in Nairobi, Amref’s vision is to create a lasting health change in Africa. It has a presence in all the 47 counties of Kenya, including programmes in hard-to-reach and marginalised areas. Amref Health Africa in Kenya’s mission is to transform the health of communities through primary health care, with a focus on women and young people. Learn more at www.amref.org.

ENAI-Africa advocates for gender rights, aiming at gender equity, food security, and quality health in Kenya and Africa’s indigenous communities. It supports education and socio-economic progress within these communities. With a focus on preserving indigenous wisdom, promoting good governance, and sustainable resource use, ENAI-Africa strives to uplift living standards. It also champions human rights, providing technical assistance for community-driven development, and fostering accountability, ownership, and sustainability by leveraging local skills and expertise. Learn more at www.enaiafrica.org. 

Financing Alliance for Health (FAH) is an African-led organisation dedicated to supporting African governments in the establishment of favourable policies for primary and community health systems. By collaborating with both the health and finance ministries, FAH advocates, influences, and secures domestic on-budget lines. Its approach is rooted in the understanding that while ministries of health define technical agendas, ministries of finance are pivotal as custodians and key decision-makers in the budgetary allocation of domestic resources. Learn more at www.financingalliance.org.

Founded 16 years ago, Living Goods, headquartered in Nairobi with core operations in Kenya, Uganda and Burkina Faso, is a non-profit organisation with long heritage on the utilisation of digital tools as means to enhance quality of service delivery at the community level. Living Goods saves lives at scale by supporting digitally empowered community health workers who deliver care on call – making it easy for families in need to get the care they need. Living Goods works with governments and partners to ensure community health workers have access to digital technology and medical treatments, and are effectively supervised and compensated to deliver high-quality and cost-effective services. Learn more at www.livinggoods.org.

Founded by a group of committed Kenyans, Lwala Community Alliance unlocks the potential of communities to advance their own comprehensive well-being. It trains community health workers to deliver services to households, strengthen community-led accountability mechanisms, and partner with governments to adopt policies and practices that strengthen health systems. The organisation’s core belief is that when communities lead, change is lasting. Learn more at www.lwala.org.

Medic designs and deploys world-class, open-source software to support health workers as they deliver quality, timely, equitable care to everyone, everywhere. Medic advances equitable care and strengthens community health systems by building, innovating, applying, and scaling open-source, low-cost digital health tools in collaboration with governments. Medic serves as the technical steward of the Community Health Toolkit (CHT), a leading open-source platform for digital health and advanced community health systems.  Learn more at www.medic.org.

Unicef works in the world’s toughest places, to reach the most disadvantaged children and adolescents, and to protect the rights of every child, everywhere. Across more than 190 countries and territories, Unicef does whatever it takes to help children survive, thrive and fulfil their potential, from early childhood through adolescence. Learn more at www.unicef.org.