Community Health Promoters Strengthening Universal Health Coverage

Jescah Chemutai is a Community Health Promoter (CHP) from Choruapkirgir village,Kapkatet in Kericho County.She has been helping her community access healthcare services for the last four years.

I met Chemutai at the ongoing Universal Health Coverage Conference in Kapkatet Stadium, Kericho County. She explains that her phone is always busy as a CHP, even during late hours. Chemutai starts her daily activities by conducting her normal household chores before setting off. “I have to lead by example before I go to meet the local community,” she added.

Armed with a fully equipped community health toolkit, she visits and registers close to 5-7 households daily, then assesses any sick person within the households. She then refers the complicated medical cases she picks from the households to level 2 health facilities in her jurisdiction.

She recalls one time when she had to respond to a distress call from a community household at night. Chemutai had just closed the day and retired to bed only to be woken up at midnight by phone calls.

“I received a call from a community member at night, and the first thing that crossed my mind was that maybe we had been raided. I remember it was pitch dark; I had to remove my torch from the toolkit and run to save a life,” Chemutai told Science Africa during an interview. On a busy day, she can work from 10:00 a.m. up to around 9:00 p.m.

“I am very happy that the doctors at the facility where I had taken the patient were able to rescue him. Indeed, that was the highest moment of my community work.”

She narrates that the challenges faced by her community motivated her to become a CHP.

“There were sanitation and pollution challenges in my community, and I wanted to be part of the solution. So, I started by informing the locals about the importance of having a latrine and how to dispose of waste,” Chemutai, who represents Nganaset unit noted.

“I decided to be the voice of the voiceless because they were not ready to talk about these issues.”

Until she fully immersed herself in serving the community’s health needs in 2020, at the peak of the COVID-19 pandemic, Chemutai was a casual labourer who would occasionally search for menial jobs in the village to fend for her family.

However, when the menial jobs were not forthcoming, she would find herself in the market hawking. “I used to sell onions and tomatoes at the local market to earn a living, but I still wanted to represent my community,” she said.

She explains the COVID-19 pandemic took the healthcare systems in disarray. The Ministry of Health relied heavily on CHPs like Chemutai(then christened community health volunteers) to reach the last mile with commodities.

“Since I had interacted with the community, they could easily relate and adhere to the Ministry of Health set guidelines at the height of the pandemic, such as hand-washing and sanitization, putting on masks, among others,” noted Chemutai. But the success and horror stories of CHPs mirror those of the unsung heroes of the primary healthcare systems.

Apollo Ougo is a model CHP from Nakuru County. His work involves mobilizing and sensitizing the community on health issues.

The Diploma in Social Studies graduate gained interest in community health service in 2003 after undergoing training organized by an international organization soon after graduation.

Even before he was on board as a health promoter in Nakuru County, Ougo had already been helping the elderly with chronic illnesses and pregnant women within his community.

“I used to attend social events and activities related to health in the community. At that time, I was linked to the health and social services department, so I became a unique, resourceful person who could talk to society,” Ougo added.

In 2009, Ougo attended a government-sponsored training on community health. He has, however, undertaken several online courses offered by different organisations dealing with health matters to sharpen his skills.

“Online classes have been helpful in my work. I have gained a lot in terms of community health knowledge and certified in this field,” Ougo noted.

His unit has around 100 households. But, he explains, there are households that he has to frequently visit because they are critical.

“I have to visit households of women who have children below one year or those who are pregnant for monitoring purposes. When I look at a pregnant women’s clinic book and find out they have attended all the clinics, I feel good,” Ougo noted.

“I’m very happy that in Nakuru County, for example, a lot of pregnant mothers are now attending clinics. It has helped us to reduce maternal and perinatal deaths.”

His motivation stems from, he adds, “The desire and the need to help people in the society to access health, especially the elderly with non-communicable complications. Seeing a healthy community and neighbour motivates me to wake up every morning to do this job.”

Already, tremendous changes are happening to position CHPs as the centrepiece of the Universal Health Coverage transformation for the country.

Health Cabinet Secretary Susan Nakhumicha revealed plans by the government to develop a national health digital superhighway to improve the management of health records.

Nakhumicha said that the lack of timely and reliable data has been a major impediment to achieving proper health outcomes.

“We want to ensure that we create an interoperable environment where all service providers and stakeholders within the health sector can connect on a digital superhighway,” the CS told reporters on the sidelines of the ongoing conference.

Patrick Amoth, Acting Director General of Health, noted that digitization of health records is a key pillar in UHC implementation.

If we can leverage technology, we can create synergies, efficiencies, and effectiveness to power our health systems,” said Amoth.

For decades, CHPs used paper registers to track households, compromising the quality of care they provided. Today, Chemutai and Ougo rely on the Electronic Community Health Information System(eCHIS), a new digital platform to advance UHC.

It features a data-driven task list, real-time performance dashboard, and automated reporting into the Kenya Health Information System, thereby enhancing the efficiency of CHPs as they deliver services at home.

“We are now able to reach many people in the community. It has also enabled us to conduct follow-up for treatment defaulters easily,” said Chemutai.

But it has not been all rosy for the CHPs. They cite a major challenge: a lack of security, unresponsive households, and inconsistency in availing of the stipends.

According to Chemutai, she longs for a period in her community health career where she will visit every household with the right sanitation facilities, with minimal cases of diarrheal diseases.

“I have created awareness on the major issues of WASH in my community, things to do with malaria prevention, among others. I will be happy when the community will no longer be recording some of these preventable diseases in the next three to ten years,” she said.

Article first published on https://news.scienceafrica.co.ke/kenya-community-health-promoters-strengthening-universal-health-coverage/