Western Kenya has some of the worst health indicators in the country. This situation is at its worst in rural communities, where women and young people are particularly vulnerable to unwanted pregnancies, sexually transmitted infections, sexual and gender based violence, unsafe abortions and maternal mortality.
Despite the fact that Kenya has a strong community health policy, several social and systemic factors prevent it being properly implemented. One fundamental problem is poor communication between health service providers and clients. Healthcare providers often feel burdened and are working under high pressure, leading to a dominant and unfriendly attitude towards clients. Clients are often treated in an unfriendly way, which makes them reluctant to visit health facilities. The culture of dominance among service providers on the one hand, and the silence among clients on the other, makes it difficult for the needs of the communities to be heard. Moreover, local authorities are failing to take the lead in financing health facilities and enforcing existing health policies.
Simavi and TICH-GLUK (Tropical Institute of Community Health of the Great Lakes University of Kisumu) have been working together for over 13 years to improve the sexual and reproductive health of women and girls in communities in Western Kenya. The goal is to improve contact between communities, local governments and formal healthcare services, and make sure local governments uphold their responsibilities and commitments.
A key element of our approach is to bridge the gap between the community and health care providers by forming and training community health committees made up of representatives from the community and the health care system. At household level, Community Health Volunteers (CHVs) are trained to with individuals and families. We also train Community Health Extension Workers (CHEWs), who facilitate regular Community Dialogue sessions to discuss the current health situation in the community. The sessions focus on building consensus between the community and health workers and formulating a joint action plan with specific targets, using monthly data on health statistics collected by the CHVs.
To make regular dialogue, planning and action much easier, communities are divided into Community Health Units (CHUs). A functioning CHU consists of:
- Committees at village, community and health facility level, where health service providers and clients make decisions together on community health.
- CHEWs: professional health workers employed by the health system, who live and work in the community. They facilitate the dialogue at community level.
- CHVs, who provide support to households in health improvement initiatives.
- Village health registers that provide community-based information on the health status of every household.
- Suggestion boxes at health facilities. These offer clients a way to make their voices heard on the services they receive.
TICH-GLUK’s community partnership model is an excellent example of how Simavi’s approach to community health works in practice and how results are sustained. Concrete results include:
- Improved performance of health committees, leading to the construction of laboratories, maternity wings, latrines and water tanks
- Improved management within health facilities, leading to better performance and service
- Improved health outcomes, such as immunisation coverage, childbirth in health facilities, use of insecticide-treated nets, and treatment of drinking water
The continued existence and success of the 170 community health units we have set up in Western Kenya shows how working closely with local civil society can ensure the sustainability of community programmes – even after an intervention is completed. Thanks to the proven effectiveness of CHUs, the government of Kenya adopted this model in 2006. Since then, the Ministry of Health has made community participation part of the national community health policy, with the aim of accelerating the achievement of the Millennium Development Goals in Kenya.
For more information on this case, please download the accompanying factsheet here.