Community health workers boost counties universal healthcare bid

Loyce Anyango holds sensitisation meetings with members of her Kandiege village in Homa Bay County every month.

She is fondly referred to as nyamrerwa - the local name for community health promoter (CHP) - and sensitises the villagers on the importance of maintaining general hygiene as the country continues to recover from Covid-19.

"No one wants to miss Anyango's meetings. She has taught us a lot about our health and sometimes gives us painkillers and vaccinates our children," says Grace Aketch.

Anyango is aware that the government is planning to train all CHPs and give them standardised kits to enhance their medical response at the community level, and she is excited.

"These kits will make our work easier. I hope they will train us adequately on how to use them to enhance preventive and promotive care," she says.

Tharaka Nithi Governor Muthomi Njuki who is also the chair of the Health Committee in the Council of Governors (CoG) says CHPs are crucial drivers in advancing preventive health, and equipping and empowering them are key to achieving Universal Health Coverage (UHC).

"The comprehensive responder kit provided by the national government will help the health workers to collect and record information daily. This will boost CHPs' contribution to improving preventive healthcare instead of cumulative healthcare at the grassroots. This is what the mwananchi needs," says Njuki.

Monthly stipend

The State has committed to match up the monthly stipend the counties have given CHPs and cap it at a minimum of Sh5,000 for the first three years.

"We appreciate that health is a devolved function and everything the national government does is with the blessings of and in collaboration with the county governments so that we can achieve UHC together," says Dr Thuranira Kaugiria, a member of President William Ruto's advisory team on health.

The State will have reviewed the plan before the end of the three years, says Dr Thuranira, and found a more sustainable way of remunerating CHPs.

"As we monitor the progress of the implementation of the partnership between the national and county governments, further deliberations shall be held," he says.

The State launched a pilot UHC programme in 2018 in four counties. The plan was to roll out the programme to the rest of the country in 18 months, but this did not happen.

The rollout is slated for October this year. Dr Thuranira says they have learned from the previous government's mistakes and have put measures in place to ensure the third attempt at the national rollout of UHC succeeds.

One of the mistakes, he says, was input financing, which led to an increase in the utilisation of medical supplies and services that had yet to be planned for.

"The mistake of input financing is that the national government decided to buy everything without involving the piloting counties. This led to a surge of intake of health services because everybody had been told everything was free," he says.

"The second mistake was that the piloting counties decided to reallocate their health budgets to other functions because the State was funding health."

Devolution funds

Kenya's UHC programme has four pillars - health financing, human resources for health, Integrated Health Information Management System, and health commodity security.

Health financing has been a bone of contention between the two levels of government, with counties constantly blaming the National Treasury for delayed disbursements of devolution funds.

For Mary Mwami, the manager of the Advance Domestic Health Financing Project at the African Institute for Development Policy (AFIDEP), the problem with UHC implementation regarding health financing is two-fold.

First, despite Kenya increasing its allocated budget share to health, the allocation still needs to catch up to the 15 per cent of the national budget that African governments agreed to in the Abuja Declaration.

Secondly, UHC focuses on primary healthcare, including promotive and preventive health. However, higher budgets, both at national and county levels, still go to curative health.

"Donors are the main funders of promotive and preventive health. High government expenditure goes to governance and administration, most of which is salaries," said Mwami during a health advocates' meeting organised by AFIDEP and Partners in Population and Development Africa Regional Office in Nakuru in mid-June.

Kirinyaga governor and CoG chair Anne Waiguru says the State allocation to the health sector is 11 per cent. Still, counties have progressively increased or maintained their health allocation at 30 per cent of the county budgets. "County governments have incrementally funded preventive and promotive health, improved patient care and diagnostic capacity, and increased the health workforce," she said in her State-of-Devolution address on June 30.

"To boost access to health services at the lowest level, county governments have recruited approximately 107,839 CHPs, and their invaluable contribution is recognised through stipends."

According to the World Health Organisation (WHO) Database 2020, up to 80 per cent of Kenya government's health expenditure goes into curative health.

Governor Njuki agrees with these findings, noting that county bosses have committed to shifting focus to preventive and promotive health.

"We have focused on curative health for the longest time, which has, in turn, used many resources in the health department. When we turn to promotive health, we are likely to reduce hospital visits and decongest our hospitals," he says.

Governor Njuki says one of the best ways to ring-fence health funds is through the facility improvement fund.

"Thus far, 27 counties have enacted the Facility Improvement Financing (FIF) Act, and 16 counties are already implementing their FIF Acts. The other 20 other counties are in the process of having the FIF legislation enacted," he says.

Under the UHC's health commodity security pillar, Dr Thuranira says the State plans to leverage economies of scale and pooled procurement for medical supplies to reduce their cost for Kenyans.

President Ruto has said his administration will work with counties to support primary healthcare and deliver UHC.

"We will train and equip 100,000 community health promoters to achieve the ratio of one promoter for every 100 families," Ruto said.