By: Mark Mwenda
Kenya is a country that has faced numerous challenges in the health sector over the years. After devolution- decentralization of political and administrative power to counties – was adopted in 2013, Kenyans expected the county governments to play a more significant role in improving community health. However, despite the efforts made over the last decade, there are still gaps that need to be addressed to ensure that the community health system in the country is effective.
One of the major challenges facing community health in Kenya is the lack of accountability by elected leaders. During political campaigns, gubernatorial aspirants often make promises about improving community health in their counties. However, once elected, these promises are forgotten. Kenyans tend to make political decisions based on who has more money, rather than the accountability records, beliefs, or values of candidates. This has resulted in the failure of county governments to promote preventive health through the tier 1 (community health) as expected, jeopardizing the overall well-being and resilience of communities across the nation.
In most counties, civil society organizations implement short-term programs and projects on community health. They involve community health volunteers (CHVs) and community health assistants for short periods, offering small remunerations to the volunteers. However, many county governments do not pay CHVs and it is impossible to survive in a capitalist country on a purely voluntary basis. CHVs need to cater to their basic needs, making it essential for county governments to provide them with sustainable stipends.
In addition to the lack of stipends, CHVs are not provided with the necessary kits, which are their tools of work. The few kits available have to be shared by at least 20 CHVs, making it challenging for them to work effectively. This has led CHVs to lose interest in their work, as they feel unappreciated and unsupported by the county governments.
The referral system from the community level to other tiers is another challenge facing community health in Kenya. There is no unified or standardized referral system, and the community health volunteers lack the tools to facilitate smooth transfer of care. Due to this gap, community members are not aware of the referral system, as is evidenced with the high number of patients struggling to get health services in top, Level 5, county hospitals in the counties. These hospitals are meant for referred cases from the lower health levels, but without an effective referral system, patients are left stranded and without care.
Another challenge facing community health in Kenya is the lack of payment of debts on health by county governments. This makes it hard for effective service delivery, as suppliers like the Kenya Medical Supplies Authority (KEMSA) cannot continue supplying to the counties due to payments owed. On 16th April 2023, KEMSA indicated that county governments owe them over 3 billion Kenya shillings (approximately US$21.5 million), limiting their ability to continue supplying to the counties, and county health facilities from the lowest levels are left without medical supplies for community members.
Despite these challenges, there have been some positive strides made in community health since devolution was adopted. The implementation of the new constitution led to the establishment of county governments, increasing accountability and responsiveness of the local governments to the health needs of their communities.
The national government has also made some efforts to improve community health in Kenya. For instance, the president, Dr. William Ruto, recently announced that he would facilitate the supply of standardized CHV kits to the 90,000 CHVs in the country and that they would also change their name from community health volunteers to community health promoters. He also announced that, together with the council of governors, they would give the community health promoters standardized remuneration across all 47 counties. These efforts, if implemented effectively, can go a long way in improving the status of community health in Kenya.
To further address the gaps in community health, it is important to promote education and awareness among community members. Many people in rural areas lack knowledge about basic health practices and disease prevention, leading to a high incidence of preventable diseases. By providing education and training on proper hygiene, sanitation, and disease prevention, community members can take more control of their own health and reduce the burden on the healthcare system.
It is also crucial to increase investment in primary healthcare services, including preventive and promotive health services, to reduce the burden on secondary and tertiary care facilities. This requires increased funding from the government and other stakeholders, as well as better planning and management of resources to ensure effective implementation of programs.
In addition, there is a need for greater collaboration between county governments, civil society organizations, and the private sector to improve the delivery of healthcare services in the country. The private sector can play a key role in providing funding, expertise, and innovative solutions to help address the challenges facing the healthcare system.
Another important step is to prioritize the recruitment and retention of qualified healthcare professionals, particularly in underserved areas. The shortage of healthcare workers, including doctors, nurses, and other medical personnel, remains a major challenge in Kenya, particularly in rural areas. This can be addressed by increasing incentives for healthcare professionals to work in underserved areas, such as offering better pay and working conditions, as well as providing opportunities for career advancement and professional development.
There is a need for greater accountability and transparency in the management of healthcare resources at the county level. This can be achieved through improved monitoring and evaluation of healthcare programs, as well as greater participation and engagement of community members in the planning and implementation of healthcare initiatives.
Ultimately, while there have been some positive developments in community health in Kenya since the adoption of devolution, there are still significant gaps that need to be addressed. By acknowledging the integral role of CHVs and investing in their capacity, counties can lay a strong foundation for achieving improved community health in Kenya. Investing in CHVs not only enhances the capacity of the healthcare system but also strengthens community engagement and ownership of health initiatives. It is through the collective efforts of all stakeholders, including governments, civil society organizations, and community members themselves, that the vision of universal healthcare coverage and better health outcomes can be realized. Let us rally together, prioritize community health, and ensure that no one is left behind on the path to a healthier and thriving Kenya.
