Communities key to promoting quality healthcare, says experts

Maureen Kimani, head of Community Health at the Ministry of Health. [Mercy Kahenda, Standard] Health experts have underscored the importance of community engagement in enhancing access to quality healthcare amid efforts to realise Universal Health Coverage (UHC). Benson Ulo, Global Fund TB Grant Programme manager at Amref Health Africa, said communities are well-versed in the health challenges they encounter. Moreover, community participation in budget processes has led to increased funding for HIV, TB, and malaria programmes. "Planning for health services has traditionally been dominated by health experts; however, involving communities is crucial as they are the recipients of these services. They must be at the table to design, implement, and monitor programmes," explained Ulo. Maureen Kimani, head of Community Health at the Ministry of Health, recognised the pivotal role of communities in accessing quality healthcare. The remarks were made at the second National Community System Strengthening knowledge dissemination forum in Naivasha. The event convened various organisations engaged with communities, community health advocates, and specialists. Representatives from Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR) were also in attendance. The forum's objective was to disseminate knowledge about new developments in health spaces and share organisational capacities bolstered by donor support. "Involving those affected by or living with diseases is a significant step towards improving health outcomes," Ulo remarked. Community system strengthening has been instrumental in combating major diseases such as malaria, TB, HIV and supporting Sexual Reproductive Health Rights initiatives funded by Global Fund and PEPFAR. The fund focuses on resilient and sustainable systems for health with an emphasis on community system strengthening. "We are collaborating closely with the Ministry of Health to fortify community systems," Ulo added. "Community involvement is imperative." As donor funding diminishes, communities are also being equipped for resource mobilisation from government entities and donors. Engaging communities also promotes accountability among service providers through community-led monitoring. "The pandemic has highlighted the importance of preparedness. Empowered communities can be trusted to design initiatives and mobilise resources for substantial national support," observed Ulo. Community strengthening enables residents to report service shortfalls, such as drug shortages in hospitals. Homa Bay has been cited as a successful example of community strengthening through 'eye monitor', a model recommended for broader adoption. Dr Kimani stated that community health promoters aid in early disease diagnosis for timely referral and treatment, thus reducing curative costs. "Since initiating the CHP agenda in 2018, we've made significant progress. CHPs contribute to a robust health system," Dr Kimani said. However, she noted that advocacy is needed to facilitate CHP operations smoothly. "Advocacy at various governmental levels is essential for recognising the importance of CHPs," she added. Ministry data indicates that only 20 counties provide stipends to promoters, with 27 counties yet to commit. There are 107,000 community health promoters nationwide, each entitled to a stipend of Sh5,000 - a responsibility shared between counties and the national government. Kenya Creative Mechanism for Global Fund representative outlined four pillars of community health strengthening: institutional fortification, social contracting, community-led monitoring, and advocacy with research. With escalating pandemics, more funds have been allocated for future crises such as floods which severely impact communities. "Communities must be prepared for effective response management around HIV, TB, and malaria to ensure precise information gathering," said Nyakwema. He emphasised that community involvement is crucial in disease management by identifying symptomatic individuals for screening and diagnosis. For instance, TB prevention efforts involve community-based patient identification followed by hospital referrals for treatment. Evaline Kibuchi, Chief National Coordinator of Stop TB Partnership, highlighted that communities are often the first point of contact for TB patients; hence their participation is vital in curbing disease transmission and infection rates. Despite progress towards eradicating TB by 2030, approximately 17,000 deaths were reported in 2022 - a drop from 33,000 in 2019. Kenya is among top 30 countries with high number of TB cases, contributing to 80 per cent of TB burden globally. "Engaging communities in TB response has played a big role in reducing TB deaths. As we move to end the disease, we need to have health services that are accessible, acceptable and affordable," said Kibuchi.

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