In Kenya, the Community Health Strategy (CHS) was for the first time included in the 2006 - 2010 Health Sector Strategic Plan in efforts to improve community health status. It is an approach for involving and engaging people in their communities in health promotion, disease- prevention and first line curative activities. People also learn how to make better use of health facilities in their areas with resultant improvement in health care and development much faster than when communities are left out. Through the Community Health Strategy, the community level has been formally recognized as Level 1 (the Foundation) of the National Health Care System. The Community Health Strategy links into the objectives of vision 2030 of improved quality of life for all Kenyans, and further extends into meeting the Sustainable Development Goals (SDGs).
CHEWs CHS training certificate award by Dr. Shiwalo, County Government. Kisumu
Community Health Approach brings Health Care Services close to the people in their villages and households with the Community Health Workforce coming from the community itself, thus ownership to solve community health and developmental challenges.
Community level workforce consists of three categories i.e.
- Community Health Committees (CHCs) - provides overall leadership and governance oversight.
- Community Health Extension Workers (CHEWs) - responsible for technical health activities in the community and provides overall management of health services at the community level as well as supervising the CHWs
- Community Health Volunteers (CHVs) - works directly with households in the villages in which they live.
Men and women collectively participate in Community Dialogue sessions guided by the health problems identified with the aim of finding solutions to the problems. The Global Fund recognizes that strong health systems and strong community systems are essential for ensuring its investments have the biggest possible impact. However, it also recognizes that while health systems are a relatively well defined and understood concept at the country level, this is not always the case for community systems; and the contribution that strong community systems can make to effective responses to AIDS, tuberculosis and malaria is not always recognized and supported.
Global Fund Framework defines CSS is an approach that promotes the development of informed, capable and coordinated communities, and community-based organizations, groups and structures. CSS involves a broad range of actors including community groups, community-based organizations and networks, enabling them to contribute as partners alongside other actors to the long-term sustainability of health and other interventions at the community level, including an enabling and responsive environment in which these contributions can be effective. The goal of CSS is to achieve improved health outcomes by developing the role of key affected populations and communities and of community-based organizations in the design, delivery, monitoring and evaluation of services and activities. From the point of view of the Global Fund, CSS leads to more effective prevention, treatment, and care and support programs for people affected by AIDS, tuberculosis, malaria and other major health challenges.
CHVs Kits distribution
Community systems are structures and mechanisms through which community members, Community-Based Organizations and other actors respond to the challenges and needs they face. Community Based Organizations have abilities to identify, understand and respond quickly to the needs of those who are made vulnerable as a result of social and structural factors, and who are affected by inequitable access to health and other basic services. They often play a role in delivering services (particularly non facility-based health services, and other social services), and they are also essential to ensuring that formal health systems are responsive to needs of community members. Community actors also operate outside the mainstream health systems in protecting the health and human rights of people who are marginalized or criminalized i.e. undocumented migrants, sex workers, sexual minorities or people who use drugs. Strong Community Systems also play an important role in facilitating community participation in: design, implementation and evaluation of programs and services; advocacy; creation of demand for good-quality health services and equitable access; addressing broader determinants of health including gender inequalities and human rights; and promoting meaningful community engagement in health-related governance, oversight and accountability, referrals for access to services and follow-up, counselling, providing nutritional support and Comprehensive Home-Based Care. As such, community action on health is an important complement to clinical or facility based health services, as it helps to ensure the right people are reached for maximum impact, and that broader determinants of health are addressed. Support to community systems also builds ownership of health and developmental problems, and through this ownership communities articulate solutions and play an important role in implementing them.
Global Fund Framework identifies 6 core components which make up CSS programming. The Six Core Components of Community Systems are:
- Enabling environments and advocacy – including community engagement and advocacy for improving the policy, legal and governance environments, and affecting the social determinants of health
- Community networks, linkages, partnerships and coordination enabling effective activities, service delivery and advocacy, maximizing resources and impacts, and coordinated, collaborative working;
- Resources and capacity building – including human resources with appropriate personal, technical & organizational capacities, financing (including operational and core funding) and material resources (infrastructure, information and essential commodities, including medical and other products and technologies);
- Community activities and service delivery – accessible to all who need them, evidence‐informed and based on community assessments of resources and needs;
- Organizational and leadership strengthening including management, accountability and leadership for organizations and community systems;
- Monitoring & evaluation and planning including M&E systems, situation assessment, evidence building and research, learning, planning and knowledge management.
Currently in Kenya, CHVs work for free supporting their communities at their own financial loss. They juggle between looking for farming income and helping their communities on health and development. In Kenya, the Global Fund Projects supports a few with stipends at KShs. 2,000 (about USD 20) a month which is way below what an average family consumes in a month. CINCO has so far implemented various aspects of Community Strategy and currently financed by the Global fund to fight Malaria and Tuberculosis. CINCO works to ensure that the CHVs are well supported to deliver on their activities/meeting community expectations, for wholesome healthy and developing communities. We work to effectively contribute towards achieving the Kenya Vision 2030 and meeting the Sustainable Development Goals (SDGs), the Global Goals 1, 3, 5 and 6.
We strive to provide them with Bicycles, Community Unit Health Information System (CHIS) Boards (for recording health issues for community dialogue and way forward) and CHVs kits/pack for clients’ attendance and replenishment as well as supporting the CHVs towards financial growth as they do a lot of voluntary work at the expense of their families.
CINCO seeks support:
- To purchase and provide Community Unit Health Information System (CHIS) Boards and CHVs kits/pack for clients’ attendance. Please Click to Donate.
- Refundable non interest earning financing for business start up. Please Click to Donate.
CINCO officials receiving CHV kits from AMREF
Nyalunya CHVs with Sub-County community health strategy coordinator
CHVs Preparing for community action day