By: Mark Mwenda
Historically, and across professions, supervision has been an endeavor of task oversight and punitive, critical corrective actions. Supportive supervision is considered the best practice for community health worker (CHW) in international settings and includes collaborative reviews, observations, monitoring, constructive feedback, participation, problem solving, training, and education. Such a comprehensive supervisory strategy in Kenya is of particular importance to the success of Community Health Volunteer (CHV) programs and facilitates the empowerment of CHVs.
Supportive supervision to community health workers is critical in improving their motivation and engagement. In this column, we hear from Neema Nyambura, a community health assistant (CHA) in Kenya. Previously known as Community Health Extension Workers (CHEWs), CHAs are tasked with supervising CHVs. Neema will take us through her experience supervising community health volunteers.
Smiling intensely, she starts by admitting that, “Being a CHV is a calling; success in the role depends on certain personal qualities such as being a natural helper, being creative and being resourceful.
I have been a Community Health Assistant (CHA) in Kiambu County, Juja sub-county since 2020. The years I have engaged with CHVs are so far the best in my career. With the help of CHVs, the roles of CHAs in Kenya include: visiting homes and determining health situations, speaking with household members, identifying and referring health cases to appropriate health facilities, identifying and sensitizing communities on health interventions, monitoring growth of children under age of five years, and identifying defaulters of health interventions and referring them to appropriate health facilities. The geographical ward I supervise has seven Community Health Units (CHUs) that are served by 70 CHVs with one major health facility supporting in health referrals.
I respect community health volunteers a lot due to the work they do despite not being paid by the government. As trusted community members, CHVs can support marginalized patients in addressing unmet needs, navigating the healthcare system, informing health behaviors, and supporting communities in addressing the underlying causes of health inequalities.
Whenever need arises, they are always ready to adjust their commitments and perform tasks that I assign them. I always compare CHVs with first aid. First aid is the crucial part in saving a life that is in danger of loss yet many are not aware or they completely ignore. Like first aid, CHVs are very crucial in promotion of health in the communities, yet their roles and services are ignored by major health stakeholders.
CHVs look up to me as the only person with answers and solutions to issues they face in the community. They always keep me updated on matters arising in the community, including those that are not aligned to my department. As a CHA, I have trained myself to work with other government and non-governmental agencies in finding an effective solution in such circumstances.
I often remind community members to elect leaders who give priority to the health sector. This is because whenever a community is healthy, all other sectors of the society run effectively. After the recently held general elections in the country, I hope the newly elected members of county assembly in Kiambu County will prioritize the health needs in the county and pass the pending health bills in the county assembly to facilitate effective functioning of the CHVs program in Kiambu County.”
When asked for her views on the effectiveness of the community health program in Kenya, Neema had this to say: “I think the CHV program was and is a great approach that the government of Kenya took in addressing health issues that the citizens face. It has brought about a big improvement in the country, based on the statistical records of the health sector in Kenya fifteen years ago and the current statistics. However, there was minimal investment in the implementation of the program causing many gaps in this sector.
It is a result of these gaps that many CHAs face a central challenge in retention of community health volunteers. Many are unable to balance their roles as CHVs and other work they do for income. As a result, they end up opting out as CHVs. When this happens, I have to find other individuals within the community to fill the gap. Unfortunately, this weakens the community health package because the new CHVs are not undertaken through a quality training of their work as CHVs. Another major challenge is that CHVs’ tools of work such as CHV kits and personal protective equipment are not provided. An example is in the ward I serve where one CHV kit is shared between two community health units, with one of the CHV from either of the health unit being the custodian. This becomes hard to offer services to the community effectively.
Nevertheless, my goal is to work towards a future where there is enhanced healthcare services and patient outcomes with improved preventive, promotive and rehabilitative health of community members in Kiambu County.”