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Here's where to start if you want health coverage for all

By Dr. Githinji Gitahi | August 2nd 2018

During this year’s World Health Worker Week, I decided to spend a few days as a community health worker (CHW) in order to appreciate firsthand the experiences, they go through in delivering healthcare to their communities.

On my first day, I visited two homes in Kanzokea, Makueni under the guidance of Pastor Mathias Muthoka, a Community Health Volunteer. During that first visit, I met the mother of a three months old baby with a Cleft lip and cleft palate which was affecting her feeding pattern as breastfeeding was not possible due to the deformity.

Long waiting list

Although the mother had been visiting Kenyatta Hospital to seek treatment for this condition, there was a long waiting list which meant that the baby required more diligent care to prevent possible infection and malnutrition.

I was heartbroken after visiting the second home where a 24 years old pregnant with her 4th baby is married to an alcoholic 25 years old who comes from a family with three AIDS orphans from his siblings under the care of the grandmother and one is pregnant and out of school at 19 years.

After reviewing her case, it was apparent that the young girl due to family challenges has been missing her prenatal care. After reviewing her case I had to write a referral to see a doctor to prevent any potential health problems affecting her or her unborn child.

These are just two of the numerous cases that Pastor Muthoka has to deal with on a daily basis as a community health worker (CHW). On an average day, he covers about 10 - 20 kilometers, often on foot under the scotching sun to meet his patients.

Despite his critical role in promoting and maintaining health of the people of Kanzokea, he is not paid for his services.

CHWs are the first point of care for communities. They are the backbone of effective health systems and often come from the very communities they serve. They help to promote equitable access to health promotion, disease prevention and use of curative services at household levels in addition to improving demand and quality of health services, reducing waiting times at clinics, and reducing the workload of health workers.

CHWs have to endure harsh working conditions with minimal resources most times in areas where healthcare is acute. A majority work as volunteers, which sometimes is demoralizing, hence the huge turnover since they also require making a living. We estimate an attrition rate of up to 77 per cent.

Always at the frontline

As frontline health workers, the Community Health Workers role should be integrated into national health systems. Along with clearly defined responsibilities, they should receive ample recognition, incentives, and professional development opportunities.

CHWs are essential if the country is to achieve 100 per cent Universal Health coverage by 2022 from the current 36 percent.

Amref Health Africa has been very keen on ensuring that CHWs are recognized as part of the health workforce in the country and across Africa.

Amref has been involved in training over 70,000 community health workers across Africa through in-service, pre-service and continuing professional development to ensure that they have a clear career path and essential skills for frontline support.

Kenya can borrow a leaf from Ethiopia, where Community Health Extension Workers proved instrumental in reducing maternal and child deaths and in meeting nearly all of the country’s 2015 Millennium Development Goals on health.

From my brief experience I have no doubt that to achieve UHC and the health Sustainable Development Goals targets, long-term community health planning cannot succeed without integrating CHWs. This means that community health workers must be paid for the essential services they offer.

The decision to move to tis critical step needs to be led from the top. The technical agencies agree on the value this would bring to the health system but political leadership right from the President’s Office is what is needed to make it happen. Dear Mr President, its time.

Dr Gitahi the Global CEO Amref Health Africa Group sits on the Standard Group PLC board

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