Kenya’s Community Health Workers Shortage Undermines Universal Health Care

By: Mark Mwenda

In underserved populations, the contribution of community health workers (CHWs) is vital to the healthcare system. Preparing the health workforce to work towards the attainment of a country’s health objectives represents one of the most important challenges for its health system.

In Kenya, the government established its community health worker (CHW) program in 2006 as a key innovation of the Community Health Strategy. Within this strategy, CHWs function at the lowest level (tier 1) of service delivery structure known as the Community Health Units (CHUs). Within this structure, CHVs (commonly referred to as Community Health Volunteers) provide promotive and preventive health services at the household level. They also collect household-level demographic and health information and assist sick residents to navigate the health system through facilitation of referrals, including following up with those under long-term treatment within the community (Kenya Community Health Strategy 2020-2025). However, a shortage of community health volunteers is hindering the achievement of the Sustainable Development Goals and Universal Health Coverage in the country.

To get more insight on this, I had the opportunity to talk to Rose Njoroge, a Community Health Volunteer based in Kenya, Kiambu County. I met her in the Muthaara Health Facility, where she was busy analyzing the weekly community health referral documents for follow-up. She had this to say:

“Community Health Volunteers require recognition, support and respect for them to be effective in administering their duties. Provision of an empowering environment for CHVs is crucial for realizing utmost efficiency.

CHVs spend much of their time traveling within the community, speaking to groups, visiting homes and healthcare facilities, and distributing information. The long walking journey has a crimping effect on the performance of their work. This is worsened by the fact that they serve an extremely large population, [more] than they can manage.

Approximately two months ago, I was reading a certain document and realized that there is a universal recommendation that an individual CHV should attend to about one hundred households. However, this is not the case at all here in Kenya. An example is the area I serve, based on the population estimates of the Kenya 2019 census, over 76,000  individuals are attended to by only seventy CHVs. This means each CHV is tasked to serve over 1,000 community members. This automatically makes it hard to effectively attend to the community as expected.

Moreover, lack of transport during reporting and when visiting households for follow ups and health education and the impassable road networks, delays passing of information to the right target group at the right time. This is because of the large geographic area that a CHV covers walking, which is usually very tiresome. This has led to many CHVs quitting their roles.

During household visits, CHWs often provide action points for interventions to address health issues. However, some community members’ views contradict information explained by CHVs, which delays action. This lack of commitment by households in implementing issues raised by CHVs during household visits causes a lot of time wastage as we try to convince them. [As a result], reaching the required target on a certain activity becomes difficult.

Community Health Units located in urban areas are also difficult to operate in for CHVs. There is a constraint in client follow-up due to migration issues. In addition, the areas are densely populated with members of diverse backgrounds. As a result, it becomes difficult to create awareness on health issues in the community, due to lack of understanding among some of the community members on how to tackle specific health issues: for example, how to carry out community dialogue.”

Despite these challenges, Rose has not wavered in her role as a community health volunteer. She explains her motivating factors to give her best to the community. 

“My desire to make a positive impact on people is my major motivator. I am deeply committed to improving the health and well-being of those around me, and I am willing to work tirelessly to achieve this goal. Support from community members themselves is also a big motivation to me. Seeing the positive change in the community develops a sense of accomplishment in being able to help others and make a difference in the community. Moreover, being a CHV is an opportunity for personal growth through learning new skills and experiences that advance my life.

Ultimately, there should be an effort by community health stakeholders in supporting CHVs by the creation of more Community Health Units per administrative ward, so that we can manage to attend to the community effectively within a small geographical area. There should also be an investment on the means of movement for CHVs in the community. In healthcare, time is the most important resource and it is, therefore, important to provide an enabling environment for CHVs to reach communities easily with less time wastage.”

Rose Njoroge shares her reflections and recommendations on the CHW shortage in Kenya.