Kenya’s Community Health Volunteer Program

By: Rose Njiraini and Salim Hussein

Kenya’s Community Health Strategy aims to provide basic prevention and care services. Community Health Volunteers (CHVs) make home visits and deliver health promotion messages, treat common ailments and illnesses, and establish protocols for Community-Based Maternal and Newborn Health, among others. CHVs are supervised by Community Health Extension Workers (CHEWs) and operate within Community Health Units encompassing about 5,000 Kenyan citizens. The areas that have an active community health program have demonstrated improvements in antenatal care visits, testing and treatment for diseases like HIV and malaria, and child immunizations.

Background
The Kenyan Community Health Strategy was launched in 2006 as a means of delivering basic health prevention and promotion services. A new Community Health Policy is expected to be released in 2020.

Implementation
Kenya’s community-based health workers are called Community Health Volunteers (CHVs). CHVs deliver services in a defined geographical area location called a Community Health Unit. These Community Health Units are composed of approximately 5,000 people (or 1,000 households) and are served by approximately 10 CHVs. CHVs are supervised by Community Health Extension Workers (CHEWs), who are government employees mandated to provide health services at the household and community levels and make referrals and linkages to health facilities. As of end of 2019, Kenya had approximately 6,000 Community Health Units out of an expected 10,000. These Community Health Units are supported by 86,000 CHVs. CHVs are supported by 1,569 Community Health Extension Workers (CHEWs).

Roles/responsibilities
The main duties of CHVs are to (1) make visit homes, initiate dialogue with household members, determine the health situation, deliver key health messages, and undertake necessary actions; (2) guide the community on health improvement and disease prevention; (3) register households at frequencies stipulated in current guidelines; (4) treat common ailments and minor injuries; and (5) with support and guidance from CHEWs, implement protocols for Community-Based Maternal and Newborn Health and Integrated Community Case Management of Childhood Illness.

Training
Trainings for CHVs are based on a curriculum with 13 modules. The full curriculum takes approximately three months and consists of 324 facilitator-led contact hours in a classroom setting and 160 hours of practical experience.1

Supervision
Each CHV should receive supportive supervision monthly from a CHEW, at either the health facility or in the community. The supervision consists of training, review of reports, and household visits with a CHEW. CHEWs follow a checklist to ensure quality supervision.

Incentives and remuneration
At the end of 2018, 14 out of 47 of Kenya’s counties were paying monthly incentives to CHVs out of their own budget. The amounts varied from county to county but are in the range of US$ 20 – 60 a month.

Impact
Kenya’s community health program has led to improvements in key health indicators. Geographic areas that implement community health services have had better health indicators than those that do not. Uptake of community health services contributed significantly to improvements in antenatal care visits, deliveries by skilled birth attendants, testing for HIV during pregnancy, receipt of intermittent preventive treatment for malaria during pregnancy, exclusive breastfeeding during the first six months of life, and childhood immunization coverage.

Author Affiliations

• Rose Njiraini is a Community Health Specialist at the UNICEF Kenya Country Office.
• Salim Hussein is the Head of the Department of Primary Healthcare Services, Ministry of Health, Kenya.

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