Strengthening primary healthcare will save lives

Oliver was basking in the morning sun, shining through the window in the paediatric ward, listening to a small transistor radio whose batteries were held to the contraption with blue tape. He was bobbing his head gently to the rhythm of the beats belting out, his face glistening in the sun’s rays, a testimony of the generous amount of milking jelly smeared on his pale skin. 

Unfortunately, Oliver’s presence in the ward was heartbreaking. At only 15 years, Oliver had chronic liver failure. From what we could deduce, for the past two years, Oliver had been unwell. He had suffered from an acute illness and was treated with over-the-counter medications brought home by his father. His condition did not improve and all attempts were made to help Oliver, all except going to a hospital. 

You see, Oliver grew up in a very remote part of Kenya. The nearest health facility was miles away and access was further restricted by local inter-clan uprisings that would erupt suddenly, without warning, rendering the area generally unsafe. For a community that had been marginalised for decades, it was only natural that they would resort to their own devices to survive, hence the heavy reliance on the local medicinemen to provide care.

Oliver’s body was covered with multiple cultural treatment markings, especially on his hugely distended belly, a testimony of the effort put into trying to cure him of his illness. Unfortunately, Oliver’s condition had only worsened and he was finally brought to the hospital when it was too late to do anything other than supportive care.

Oliver’s story is not unique. It is the story of many Kenyans in this country with limited access to care. It is the stories like Oliver’s that have led to the push for the implementation of primary health care (PHC) in Kenya. PHC has long been conceived as a basic building block for the attainment of good health for the nation by focusing on reversing the trends since 2005. This was further reinforced in the Kenya Health Policy 2014-2013, but we are yet to get over the teething problems of implementation.

So far, county governments have been able to identify their community health units and assign community health volunteers (CHVs) to provide health education and community-based services to the people. However, despite data speaking to the impact of these interventions, financing PHC adequately remains a challenge. 

The Kenya Demographic Health Survey (KDHS) 2022 showed great improvement in health-seeking behaviour of the country if the antenatal clinic attendance and skilled delivery figures are anything to go by. A lot of this improvement is attributed to the good work done by the CHVs to get mothers to utilise the services provided by governments at large. 

Two years ago, if Oliver had access to a functional PHC system, he would have found himself in the hospital much earlier, at a time when he could actually get help. It probably would have saved him from his current situation, soaking up the morning sun’s rays, knowing it could be that last. 

The government has invested a lot in PHC. We now have almost 150 family physicians, the specialists tasked with oversight of implementation of PHC. Of these, a good proportion are trained in Cuba, a country that has set a benchmark for PHC. These young doctors did more than just learn the medicine of it. They learnt the passion of PHC. 

Listening to a few of them talk about the plans they have for their counties in the implementation of PHC, as a pillar for universal health coverage, one is astounded by the commitment they have to ensure their training and exposure does not go to waste. Dr Cornelia is one such a doctor. She envisions a Nairobi where it is actually possible to make PHC work. She is happy that her bosses share her vision and are willing to support her to make it happen.

Teamwork

And why should we fail? Dr Cornelia’s story is repeated across the 47 counties. As the younger members of the specialisation bring in their energy and commitment, those who pioneered the specialty such as Dr Joy Mugambi, the current chair of the Kenya Association of Family Physicians, together with other association members, have remained instrumental in providing the experience. They have tirelessly worked to advise the Ministry of Health in various fora regarding the implementation of PHC, including participating in the development of the Kenya Primary Health Care Strategic Framework. 

But, like all other aspects of healthcare, PHC is only deliverable under teamwork. The huge team behind giving PHC a face includes the clinical officers, nurses, community health extension workers, and most importantly, the community health volunteers .  It is time we changed this title. The most important pillars of the delivery of PHC cannot remain volunteers. It is unethical and unfair. We are depending on these noble ladies and gentlemen to save Oliver and millions of other Kenyans just like him, especially the most vulnerable in society, and we want them to do this without any compensation. 

In our rural settings and in our informal settlements, CHVs have tirelessly ensured babies are delivered safely, vaccinated, taken for treatment in a timely manner and fed properly to prevent malnutrition. They know the vulnerable adolescents at risk of HIV and teen mothers who are scared of seeking care. 

They are the first to identify contagious disease outbreaks and inform authorities. They ensure our chronic disease patients remain compliant with treatment and attend their clinics. They literally hold the health of their community health units in their hands. 

A big thumbs-up to the counties that have stretched their budgets thus far to pay their CHVs a token of appreciation. This must not only be encouraged but recommended. Our national government has indicated a commitment to ensure that the CHVs are included in the payroll as form July.  This is not only timely but also life-saving! This is one pledge that I am happy to hold the government to account to ensure it is fully implemented.

Dr Bosire is an obstetrician/gynaecologist