Why counties must invest in community health services

By Euridice Gatwiri and Patrick Malachi

Community health programmes are critical drivers of the attainment of Universal Health Coverage (UHC). They provide basic healthcare and health promotion services across the country, even in far-flung areas, at no cost. However, the programme is sidelined by most county governments as it receives the least funding. It therefore faces multiple challenges that undermine its potential impact.

Kenya now has an opportunity to fast-track its UHC aspirations because it has been identified as one of the 10 countries in sub-Saharan Africa to potentially receive funding starting in 2023 to strengthen its community health programme from a recently launched initiative dubbed ‘Africa Frontline First’.

Africa Frontline First was launched in May, 2022 by a coalition of four partner organisations under the leadership of former Liberian President Ellen Johnson Sirleaf. The partners are: Financing Alliance for Health, Community Health Impact Coalition, Community Health Acceleration Partnership and Last Mile Health. 

However, to receive this funding, the county governments must commit to strengthening and channelling more resources to their community health programmes, which largely depend on donor funding. 

Apart from funding 10 countries in sub-Saharan Africa to strengthen and expand their community health workforces, the Africa Frontline First initiative will also deploy 200,000 professional community health workers by 2030. These are well trained and supervised, remunerated at a competitive rate, well equipped and protected workers who deliver essential services to those in need. They also have opportunities to advance their careers in other cadres of the health workforce.

As the name Community Health Volunteers (CHVS) implies, we are not entitled to any salary for our services. Some counties give us stipends but not all CHVs get it. We mostly receive non-financial incentives such as branded t-shirts or reflector jackets from the government. The inadequate pay has led to dissatisfaction and high attrition rates of CHVs.

Our profession is marred by challenges like lacking essential equipment such as thermometers or blood pressure machines to perform some of our functions. This limits our work and ultimately erodes the confidence the community has in us. 

Unlike other health care workers, we are least likely to advance in our careers; for instance, when the county governments were filling the recently created community health assistant positions, they did not consider CHVs who have extensive experience providing community health services.  

Whether or not Kenya receives the funding from the Africa Frontline First, we hope that counties will increase their financial contributions to community health and at the same time explore funding opportunities from the private sector and other innovative approaches. 

The funding should not only target paying us stipends but also other components of the health programme such as training and provision of equipment. 

Counties need to engage CHVs as co-creators of community health solutions and capture our contributions in a way that goes beyond tokenism if they are to build responsive community health program mes. We have an in-depth understanding of the context in which we work and should thus be given an opportunity to contribute to the design and running of the programme.

Euridice is the lead CHV in Tharaka Nithi County.  Patrick is a CHVin Kibra, Nairobi County