Kenya developed its first primary health care approach in 1980, but it was primarily focused on secondary care with minimal focus on community-level participation. An evaluation of the Kenya Health Policy Framework in 2004 showed an overall decline in health-related indicators despite increased funding to the health sector. This led to the development of the community health strategy in 2006. With these national frameworks in place, Makueni county has appreciated the need to domesticate the national community health services policy 2020-2030 and the community health strategy 2020-2025 to address the gaps existing in community health services within the county.
Makueni adopted the community health program in 2006 when the national program was rolled out. By 2020, the county had increased the number of community health units by 54% since the country adopted a devolved system of government in 2013. The program has contributed to the well-being of the people of Makueni by increasing access to health services at the household level.
Makueni county has 236 government-owned health facilities, with dispensaries accounting for 76%. Faith-based organizations, non-governmental organizations, and the private sector own 24% of health facilities in the county. Ninety-seven percent of the total community health units are attached to government-owned health facilities, while 3% are attached to Faith-Based health facilities. The county has engaged faith-based organizations in strengthening community health services by building community health volunteers’ capacity, improving access to health services, strengthening community-facility linkage, generating demand for health services, social mobilization, and marketing. However, the private sector has never been engaged in community health service delivery. Makueni county is vast, covering 8,169 km2 and the distribution of government health facilities is uneven hence the need to leverage private and faith-based organizations to improve access to health services.
The County Department of Health Services and Financing Alliance for Health presented the draft community health policy and strategy documents to health stakeholders in a forum that JHPIEGO sponsored in June 2021. Stakeholders in the forum included representatives from across Makueni’s six sub-counties: Sub-County Medical Officers of Health, Reproductive Health Coordinators, Public Health Nurses, Faith-Based Organizations, private sector proprietors, and partners.
The forum discussions underscored the value of investing in community health structure and highlighting the funding gaps that exist in the program. The stakeholders were very receptive. Dr. Maundu Solomon, The Director of the Private Sector Association in Makueni county, pledged and emphasized the need to support community health structures.
“We all appreciate the value of our community health volunteers and especially at such a time the country is seeking to achieve universal health coverage. As the director of the private sector in the county, we are ready to sit down with the government and develop a partnership framework. Contribution to community strategy can be part of our corporate social responsibility. We have done this before in some of the health facilities like Rhapha Nursing Hospital, where women with Linda Mama cards access services without incurring any extra cost. We recommend that private hospitals support units within their catchment population either through training or procuring community tools. The CHVs in return should also support creating awareness of the National Health Insurance Fund and referring clients to our health facilities for us to be in a position to pool more resources to sustain the engagement. We can discuss with the government how this linkage would be defined. I strongly believe domestic funding is the way to go.”
The county Government of Makueni is keen on developing a partnership framework to define stakeholders’ engagement better and ensure continuity of services upon the exit of partners. The county is in the process of constituting a technical working group to give technical guidance on community health services.