Homa Bay CHVs; unsung heroes changing one life at a time

2,954 CHVs in Homa Bay enrolled for NHIF, given stipend

What you need to know:

  • Trained CHVs receive test kits from different organisations to collect data in their communities.
  • Part of their assignment is to promote disease prevention.

Millicent Boyi has been a community health volunteer (CHV) in Homa Bay County for 15 years.

As a level-one healthcare provider, she has earned experience in handling different ailments by advising the sick. She usually tells them what to do to stay healthy.

She is one of the people her neighbours look to whenever someone falls sick, especially at night. At her rental house in Shauri Yako, an informal settlement in Homa Bay town, Ms Boyi receives different people needing help but cannot immediately access hospital.

Her duty includes referring patients to hospital. She first calls their emergency wing. She also conducts contact tracing for drug defaulters, especially for HIV and TB patients who must take their drugs every day to stay healthy.

"Some patients give up along the way. I counsel such people and ensure they don't default on drugs," she says.

Ms Boyi has also been trained to diagnose ailments like malaria and HIV. "Part of our training was using test kits for malaria and HIV. I can also conduct a pregnancy test."

Trained CHVs receive test kits from different organisations to collect data in their communities. Part of their assignment is to promote disease prevention.

Across the country, CHVs are still despised, despite being pillars of community health. Worse still, they rarely get support from the county governments even though health being a devolved function.

When she started work, Ms Boyi survived on the money she got from non-governmental organisations that paid her whenever she referred a client to them. One NGO paid her Sh500 for every TB patient she referred.

"The recent organisation that engaged me would offer Sh200 if she referred a pregnant woman who needed ultrasound services. My colleagues and I also engage in income-generating activities; we collect waste from residential areas at a fee," she says. 

Transitioning health services to county governments brought hope to most CHVs who envisioned being listed as county employees. They were wrong.

Since the inception of devolution in 2013, Ms Boyi and other CHVs in Homa Bay have been offering health services for free, despite the previous administration promising to give them a stipend. 

Ms Boyi recalls getting paid at least seven times during the 10-year tenure of retired governor Cyprian Awiti. "Payment was intermittent. We were only paid when our services were needed the most."

She says the stipend was not wholesomely paid as one group would miss from the list of beneficiaries.

Proposed legislation that sought to have the group legally recognised flopped. Ndhiwa MP Marion Owino sponsored a bill at the National Assembly during the last term to compel all devolved units to have a standard pay for CHVs.

The county administration has now committed to addressing the plight of its 2,954 CHVs to boost their morale.

January stipends

On Tuesday last week, they received M-Pesa messages that the county government had sent their January stipend. Each person got Sh2,000.

Homa Bay County Health Chief Officer Kevin Osuri said the payment was made directly to M-Pesa accounts. "Our primary focus is on primary healthcare in line with the directive of the national government on universal health coverage."

Homa Bay has further enrolled the entire group on the National Health Insurance Fund (NHIF) to promote universal health coverage. Dr Osuri said they spent Sh1.477 million to enrol the CHVs. The payment covers the CHVs for six months, until June before more money is added.

The aim of supporting CHVs is to improve health indicators. Homa Bay has one of the worst health burdens. It leads in HIV infection at 19.6 per cent, which is four times the national average of 4.9 per cent.

It is followed by Kisumu (17.5 per cent), Siaya (15.3 per cent) and Migori (13 per cent), according to the 2018 Kenya Population-Based HIV Impact Assessment report. Other diseases that are common in the county include TB and Malaria.

Other causes of early death in the county include low uptake of vaccines, which, according to the Kenya Demographic Health Survey report, is at 76 per cent.

Dr Osuri says they are optimistic that some of the factors putting the county on the red list will be addressed with the help of CHVs. He said the issues they are keen on include antenatal services, teenage pregnancies and skilled birth. “As a government, we are committed to achieving some of our dreams."

According to the chief officer, health records indicate that CHVs in Homa Bay were last paid in June 2020. Even then, the payment was not reaching all of them. "One person would walk with money as they looked for their colleagues. Using mobile phones will reduce cash pilferages while reducing the burden of CHVs travelling to collect the money," Dr Osuri says.

He says the county assembly approved the money paid to the health workers in the supplementary budget discussed last year. He adds that the county government is not in a position to pay arrears from the previous administration. "What we did was to test-run the system. No one complained about not receiving the money. We shall pay for February next week," Dr Osuri said, adding that CHVs will be paid when other county employees get their salaries.

According to Ms Boyi, some CHVs were about to quit. She hopes Governor Gladys Wanga will clear the arrears for the six months she has been in office.