The pivotal role CHWs play in achieving Universal Health Coverage: A case of Laikipia County in Kenya

Laikipia is one of the counties with the highest National Hospital Insurance Fund (NHIF) enrollment rate nationally, with 64% of its population enrolled in the NHIF scheme as of 2020. To attain universal health coverage (UHC), the county has partnered with the NHIF to sensitize the community on the NHIF and UHC and conduct biometric registration of all registered and new members in order to allow seamless provision of services at all accredited facilities. Residents can enroll for NHIF in all the accredited facilities as well as update their biometrics in any of these facilities.

In June 2021, community health volunteers (CHVs) were involved in sensitising the community and contributing to increased enrolment of the residents to NHIF. The CHVs had also been previously involved in conducting a socioeconomic survey of households in the county to enable identification of vulnerable populations and low socioeconomic households to be supported by the county through its UHC initiative. In this regard, 4,500 households were supported to enrol for NHIF further reducing potential socioeconomic inequalities in access to social health insurance.

With a demonstrable return on investment, CHWs have been essential in the significant increase in the NHIF membership enrolment in the county, which increased from 17% in 2017 to 64% in 2020 demonstrating the county’s robust and vibrant UHC programme. In addition, CHWs continue to play a significant role of providing preventive and promotive services at the community level and have greatly contributed to the containment of COVID-19 in the county hence effectively ‘insuring’ the health system and the county from the pandemic.

In the same vein, the county health department has ensured that almost all public health facilities have been accredited by the NHIF to provide outpatient care services. In 2019, only half of the 89 public health facilities in Laikipia had been NHIF-accredited, with the number increasing by 39 in 2020, excluding the private and faith-based health facilities that are already accredited. This has allowed the residents of Laikipia county to have access to quality, affordable and accessible healthcare, and reduced the burden of out-of-pocket expenditure, protecting the residents from impoverishment due to catastrophic health expenditure.

Despite the county’s efforts in promoting UHC, unreliable internet connectivity in some of the areas in the county has hampered the biometric registration, and effective use of NHIF services. CHVs continue intensifying awareness of NHIF and its benefit packages and following-up on households to ensure regular and timely contribution to the scheme. They have also been a key link between health facilities and the communities.