By: Sa’id Gaya, Wendy Wakhusama
Health insurance remains one of the critical pathways toward achieving universal health coverage in sub-Saharan Africa. In Kenya, Laikipia County has achieved significant success with health insurance through National Hospital Insurance Fund (NHIF) enrolment. Through the universal health coverage (UHC) program, the county tremendously increased the NHIF enrolment from 52% in 2018–19 to 68% in 2022–23. Community Health Volunteers (CHVs) were particularly important in community sensitization and mobilization and in identifying at least 12,568 people in 4,500 households with incomes below the county’s poverty level for whom the county government subsidized their NHIF premiums.
This role of CHVs is acknowledged by one of the community health assistants (CHAs), who supervise at least 10 CHVs in a community health unit. Consolata, the CHA who has worked in her Naibor community for eleven years, observes that “many people are not educated and have issues with access to health, including immunization and ANC (antenatal care).“CHVs have been critical in educating communities about health and mobilizing communities to enroll in the NHIF, which has increased access to more people, particularly those with disabilities, the elderly, and orphans.”
On the other hand, Samuel—a public health officer and community health assistant from Laikipia West with 28 years of experience in community work—believes that “community health and development are inseparable,” hence his passion for the job. He observes that “the success with household enrollment in the NHIF program has eased the burden of disease in the county.”
Besides promoting the adoption of health insurance, evidence in sub-Saharan Africa and Kenya has shown that the work of CHVs has both economic and health benefits. Mr. Francis Ruga, the County Deputy Director of Nursing Services in Laikipia, notes, “Health and nation-building are inextricably linked, and the surest way to ensure healthier people is to invest in primary healthcare systems as a cost-effective way of addressing disease burdens that inevitably arise. In this conversation, CHV’s contribution cannot be overlooked”.
With the county’s plan to create “a healthy and productive county” by building a responsive, client-centered, and evidence-based health system for accelerated attainment of the highest standard of health for all in Laikipia County by the year 2030, the county will need to strengthen the provision of preventive and promotive health care services, especially by leveraging the community health strategy. This can be done through the implementation of the county’s 5-year community health strategy and increased investment in community health to match the needs.
In the fiscal year 2022/23, the county allocated 41.9% (KES 6,221,985,678) of its total budget to health. Community health strategy, advocacy, and surveillance were allocated KES 26,236,000 (KES 23,000,000 for the CHV stipend) while universal health coverage (UHC) was KES 10,000,000. Despite this allocation, the county will need to invest KES 934M (USD 8.32M) over a five-year period to strengthen the community health system in Laikipia.
Service delivery at the community level has improved across the county owing to increased community health volunteers, stronger linkages with primary health care facilities, enhanced partner support, and involvement in community health services. Laikipia aims to create a healthy and productive county by building a responsive, client-centered, and evidence-based health system to accelerate the attainment of the highest standard of health for all in Laikipia County by 2030.
Article written by Sa’id Gaya – Senior Health Finance Fellow at FAH
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