COMMUNITY HEALTH STRATEGY

Taking the Kenya Essential Package for Health to the Community: A Strategy for
the Delivery of Level One Services

Presentation
 Background of Community
Health Strategy
Primary Health Care (PHC) in Kenya
PHC implementation in Kenya commenced in early 1980s with
Kenya continuing to implement all the 8 globally agreed
elements with 4 more additional later
Despite all the effort in terms of implementation; the PHC
strategy failed to reverse the worsening health indicators i.e.
IMR,MMR etc

Community Health Strategy (CHS) in 2006

Ministry of Health through its National Health Sector Strategic
Plan II 2005-2010 came up with CHS to re-vitalize the PHC
concept. This is to be achieved through improved community
access to health care in order to reverse the worsening health
indicators.
Community Health Strategy in
Health Policy
VISION 2030
(Equitable, Appropriate and Affordable HC)

Kenya Health Policy Framework

(KHPF)

National Health Sector 3 main strategies to

Strategic Plan I (1999-2004)
implement NHSSPII
Kenya Essential Kenya Health
Package Sector-Wide Approach
National Health Sector of Health (KEPH) (KHSPAp)
Strategic Plan II
(2005-2010) (2008-2012)
Community Health
Strategy
 Key Linkages
MOH
Level 4 : NATIONAL REFFERAL SERVICES
Policy Tertiary/National hospitals
Guideline

Level 3: COUNTY HEALTH SERVICES

COUNTY HMT
Sub-County, Mission & Private hospitals

SUB-COUNTY HMT

Level 2: PRIMARY CARE

SERVICES
Health Centres & Dispensaries

Health Management Health Services

CH
C Community Health Strategy C
HU Level 1: community
Community, Villages, HH, family, individuals Health Services
 Relationship between Cohort
Essential Package
Early and and level of c
Pregnant woman and Late Children and
Youths 5-19
Adulthood
Newborn up to 28 Childhoo
days d -29 yrs 20-59 yrs
days to
59
Months
Objectives of KEPH at Level
1
Mobilize and engage communities in their
own health issues.
Provide guidance to communities as they
mobilize and engage.
Strengthen decentralization process to
bring decision making and resources
control closer to consumers (HH
occupants).
Develop community and service providers
capacity for evidence based planning,
implementation, monitoring and evaluation
of KEPH.
Objectives of KEPH at Level
1 cont..
Promote inter-sectoral, integrated and
multi-sectoral approach in implementing
community based health interventions.
Strengthen NGO and Faith Based
Sectors support to KEPH.
Ensure equitable preventive and
promotive health services for all.
Increase accountability of Health Ministry
at all levels.
 The Community Health
Strategy
is all about
The linkage between governing structures at
The linkage
different levels
The workforce to expand the efforts of the
HHs
The package of care that can be delivered
at HH, community level, by cohort
The information system designed to
enhance accountability and responsibility,
hence feed into dialogue, planning and action
by all
 CH Strategy Recognizes
that
People are busy doing their best for themselves &
HHs.
Formal system health care providers are not the only
source of knowledge, skills and ideas.
Formal system health care providers are often
unaware of what clients accept, prefer and use.
Formal system inputs must compete with the existing
expertise.
Conflict can be reduced through partnership and thus
reduce dichotomy between providers and consumers.
Both Providers & Consumers need behaviour
change.
 Strategic Objectives Of
Community Health Strategy
1. Providing level 1 services for all cohorts and
socioeconomic groups, taking into account their
needs and priorities.

2. Building the capacity of level 1 human resource

(the community health extension workers:
CHEWs and community health workers: CHWs) to
provide services at level 1.

3. Strengthening health facilitycommunity linkages

through effective decentralization and
partnership for the implementation of level one
services.

4. Strengthening the community to progressively

realize their rights for accessible and quality care
and to seek accountability from facility based
 The Approach
The Strategy builds the capacity of HHs, not
only to demand services from all providers,
but to know and progressively realize
innovative approaches of meeting the Health
needs of her population.

The approach recognizes that all communities

are already actively engaged in health
activities for the survival of their households.

Their actions for health could be strengthened

through, increased knowledge and skills base
as well as better planning of their activities.
Community Action and
Results for Health
 The Structure and
Referral Mechanism

Facility (Level 2)
Public Health Officer,
CHEW CHEW Community Health
Nurse

Supportive
Supportive
1
Co
Supervision
Supervision
Referrals Community (Level 1)
Un m
Volunteer

m
CHW CHW CHV CHV s

it un
( C it
(1CHVU
5,000 people
) y

Mobilizing and organizing of communities

Into Community Health Unit (CHU)
Community Strategy
Structures
Sub-County Health Stakeholders
forum.
Ward Health Stakeholders forum.
Health Centre Local
Council/Committee (HCLC).
Dispensary Management Committee.
The Community Health Committee
(CHC).
The Community Unit (at sub-location
level).
 The cascade
Community Health Committee (CHC)
9 members elected at Ass. Chiefs Baraza
Chaired by respected community member
CHV - treasurer
CHEW - Secretary
Includes representatives of:
Youth, Faith groups, Womens group, the Red Cross, People Living
with Aids (PLWA), People with Disability (PWD) and any others.
At least one third of the committee members should be of either
gender.
Community Health Unit Sub location level
1 CHV/200people (20 HHs) to cover about 5000 people
Coordinated by a CHC through 2 CHEWs.
The village
That has between 20 to 50 HHs
The HH
First level of care
Headed by a Care Giver/head
The index
 CS Tools
1. Tool 513 HH Register 2. Tool 514 CHW logbook
 Tools cont..
3. Tool 515 Referral tool
Type of information
collected
Type of information
collected cont..
 Community Health
Workers Recruitment
Criteria
Able to read and write Facilitates household
(atleast form 4/std8). evidence based dialogue
Belongs to local community. (key practices).

Loyal and able to Regular engagement for 40

reciprocate. days a year

Part of the household health Recognized and rewarded

team. by forums, based on output.
Takes care of 20 households, Updates the register two
maintains a register. times a year (2 home visits).
 Community Health
Workers
Trained on Health issues within all the
cohort 1 to 5
Trained on OVC care and support, HCBC,
FP, TB, MCH,
Empowered on Community Health to
empower their communities
Trained on community level M & E and tools
513 HH register
514 HH logbook summary
515 CHEW summary
516 Chalk board
Referral tool
Able to support and participate in baseline
surveys on health issues
Community Health Extension
Workers
(Coaches)
Trained Health Worker (PHO/T or CHN),
Part of the local Health Team
Refreshed on Community Health Strategy (4 weeks, 2
phases)
Able to train and supports CHWs (logistics, coaching,
referral)
Secretary to CHC, reports (tool 515) to level 2,3
Committee
Up-dates (tool 516) Chalk Board
Facilitates the CU evidence based Dialogue (key
messages)
 Some activities of the CHUs
1. Disease prevention and control to reduce morbidity,
disability and mortality
Communicable disease control: HIV&AIDS, STI, TB, malaria,
epidemics
First aid and emergency preparedness/treatment of injuries/trauma
IEC for community health promotion and disease prevention

2. Family health services to expand FP, maternal, child and

youth services
MCH/FP, maternal care/obstetric care, immunization, nutrition, C-IMCI
Non-communicable disease control: Cardiovascular diseases,
diabetes, neoplasm's, anemia, nutritional deficiencies, mental health
Adolescent reproductive health
Other common diseases of local priorities within the district, e.g., eye
disease, oral health, etc.
Community-based day-care centers.
Community-based referral system, particularly in emergencies
Paying for first-contact health services provided by CORPs
 Some activities of the CHUs
cont..

3. Hygiene and environmental sanitation

IEC for water, hygiene, sanitation and school health
Excreta/solid waste disposal
Water supply and safety, including protection of
springs
Food hygiene
Control of insects and rodents
Personal hygiene
Healthy home environment environmental
sanitation; development of kitchen gardens
Organizing community health days
 CHV Kit Content
SNO. Item Description Replenishing plan

1 Albendazole 400mg Quarterly

2 Paracetamol 500mg Quarterly
3 Tetracycline eye ointment Quarterly
4 ORS-20.5mg Quarterly
5 Zinc sulphate 20mg Quarterly
6 Combined oral contraceptives Quarterly
9 Povidone iodine solution Quarterly
10 Salter scale Once
11 Color coded salter scale Once
12 Digital Thermometer Once
13 Timer Once
14 MUAC tape Once
15 1st AID Box ( spirit, Disposable gloves, cotton
wool, strapping, crepe bandage)
 CHW Kit Content (LEVEL 1)
cont..
SNO Item Description Replenishing
plan
.
16 Chlorine/Flocculant (coagulant & disinfectant)-For Quarterly
turbid water
17 Chlorine-Clear water Quarterly
18 Lavibond comparator-for measuring chlorine level Once
in drinking water
19 DPT tablets used with lavibond comparator Quarterly

20 IEC Materials
21 Commodity register
22 Male condoms Quarterly
23 Medical dispensing Envelopes Quarterly
22 Female condoms Quarterly
23 Medical dispensing Envelopes Quarterly
Important Steps involved in
establishing CUs
Step 1 Courtesy call at SCMoH
Step 2 A meeting with CHS in-charge
Step 3 A meeting with extended SCHMT
Step 4 Schedule a divisional/Ward health
stakeholders meeting (Agree on action plan).
Step 5 Hold local Leaders Awareness Meetings
(LAM) at location level
Step 6 Form Community Health Committee
Step 7 Train CHC and agree on an action plan
Step 8 Support CHC to select CHVs and ultimately
form a CHU
Step 9 Train CHVs on strategic areas including M&E
Step 10 Support the work of the CHU
 Support for CHU
1. CHV Monthly meetings
2. Quarterly Planning meeting
3. Community Dialogue Days
4. Health Action Days
5. Integrated Outreaches
6. Selected elements of CHV kit
7. CMEs
8. Incentives(Proposed)
Bicycles
IEC Materials i.e. T-Shirts, bags e.t.c.
Skills training TB, RHFP, HIV&AIDS, Malaria,
WASH e.t.c.
Link with social determinants benefits
Monetary incentives
 Operationalization-plan
Formation and
training of CHCs &
CUs
CHC & CHW selection
Training on CS
Support new CHC,CHEW to hold
meetings
Support GoK to conduct
support supervision
Capacity Building
CU & CHC (existing)
Resource mobilization &
proposal writing
Developing and implementing
action plan
Orientation of CHEWs, CHC and
CHWs on CS
Training on CH and role of
community
Comprehensive package (TB,
HIV&AIDS, Malaria and MNCH)
Mentorship of
CHCs
National youth friendly
guideline (dissemination)
Mentorship visits
Use of COBPAR tools
Appraisal on CS tools
Appraisal CBHIS tools
New OVC tools and database
others
Support
Community dialogue
Stakeholders meeting
Referral
CHC inclusion
Referral desks
Support supervision
OJT
Build capacity of IP and GoK
to institutionalize SCQA
 Reference Documents
Taking the Kenya Manual for CHEW and
Essential Package for CHV
Health to the
Community: A Strategy CHEW Training Guide
for the Delivery of CHV Training Guide
Level One Services
Manual for CHC
Community Strategy
CHC Training Guide
Implementation Guide
Tools: 513,514,515 & KHSSP II (upto 2012)
516 Constitution of Kenya
Kenya Vision 2030 2010
 References cont...

Kenya Health Policy

Framework 2012-2030.
Kenya National Health
Sector Strategic and
Investment Plan 2012-2017.
 STATUS OF CHS

2943 CHUs established against 8726 (33.7%)

by Nov.2013
2010 Survey:
-Maternal health ANC 4times=80% against
63%
-Last birth protected against neonatal tetanus
-71% compared to 57%
-Delivery by Health professional 47% compared
to31%
-Delivery in HF45% compared to 32%
 Cont..

-HH with at least 1 net 65% compared

to52%
-Children under 5 who sleep under a
net 59% compared to 37%
-Women aged 15-49 who sleep under a
net 62% compared to 40%
 Challenges
Funding to scale up the
roll out.
Recruiting & Training
CHEWs,
training CHVs, CHEWs
and CHCs)
CHIS data collection
tools
Bulkiness, Insufficiency
CHV Kit Procurement
Quantity, Content, Supply
Inadequate Personnel
level 1 (Attrition of CHVs)
Level 2 (CHEW and
service providers)
Motivation of CHVs
Availability, Sustainability,
Harmony
Inadequate health
personnel
High expectation by
CHVs&CHC
Lack of uniformity in CHVs
motivation.
High CHV attrition rate
Inadequacies in motivation
of CHVs &CHC
Enabling factors;
Sensitized SCHMTs & CHEWs
Supportive partners
CHEWs support (motor
bicycles)
High community acceptance
for the programs.
 WAY FORWARD
Establish model CHUs
Establish a reward system for best
performers
Annual conferences for CHUs
Initiate participatory and sustainable
livelihoods to support CHUs
Exchange programs
Intra/Inter-sectoral Collaboration
THANK YOU !!!!!!!!!!!!!!!