Empowered community health workers hold the key to healthcare access for all

Eddine Sarroukh,
Senior Advisor Innovation and Technology, UNDP Kenya

Marceline Otieno, a UN Volunteer Public Health Officer working under the Joint Devolution Programme makes home visits to communities as part of the public sensitisation, risk communication, and healthcare services in response to the COVID-19 pandemic. Photo: UNDP Kenya/Jonhson Muchiri

Back in 1987, the World Health Organization launched the Safe Motherhood Initiative in Kenya, a global movement to reduce maternal mortality. Over the last 30 years, the maternal healthcare field has made considerable progress, though more work needs to be done towards safeguarding the health of mothers and their young ones. Every day, around 800 women worldwide die from preventable pregnancy and childbirth-related complications. Many of these deaths occur in low- and middle-income countries, of which Kenya is no exception. In Kenya, approximately 5,000 maternal deaths are reported annually. Maternal mortality remains high due to a lack of adequate access to skilled care and effective communication within and between health facilities, as well as limited awareness at the community and primary healthcare level.

In 2018, the Philips Foundation, together with Abrassa Mentorship and Empowerment Network (AMEN) Kenya, implemented a two-year project focusing on community health workers’ capacity building in four counties in the utmost part of Northern Kenya. The region has the fourth highest maternal mortality ratio, rating at 1,127 deaths per 100,000 live births in the country — comparing to a global average of 211 per 100,000 (United Nations, 2017). With 40 percent of women delivering at home, the region faces a significant challenge in improving maternal health.

In far-flung and rural areas in Kenya, community healthcare workers play a critical role in ensuring life-saving health services for mothers and their children are accessible and affordable. Photos: UNDP Kenya/Ngele Ali and Allan Gichigi

The impact of community health workers

One of the crucial strategies to reduce maternal mortality is improving community health workers’ skills. By providing community health workers with the necessary tools and commodities, communities can be reached in the most remote areas. As part of strengthening community-based care, these strategies are critical in saving hundreds of thousands of pregnant women’s lives around the world. Transversing across Kenya, it's evident the significant impact community health workers could bring to remote areas. In most rural and far-flung areas, community health workers provide life-saving care to their neighborhoods, extending the reach of primary healthcare systems. There should be no excuse for not delivering accessible quality health care to most remote areas and local community health workers live up to that code.

Training of community health workers enables them to identify cases earlier, reduce treatment costs, and change the course of preventable deaths in areas where primary care is not always accessible. For example, through the use of a Philips outreach kit — a backpack containing essential and innovative medical tools — health workers are empowered with high-quality equipment. It not only improves the quality of care delivered but also empowers them, building trust and credibility in their communities that support timely referral whenever it is needed.

To illustrate, Philips Foundation’s two-year project with AMEN Kenya is showing significant impact. So far, the project has trained 220 community health workers. The training, aimed at improving documentation and reporting of services offered at the primary care level, led to a significant uptake of healthcare interventions. The community health workers managed to visit almost 5,000 households, providing 28,000 people access to a wide range of healthcare services to a sparsely populated Marsabit County. We saw that by using the Philips outreach backpack, community health workers managed to increase their home visits from 66.7% to 75.1%.

Trained community healthcare workers have a deeper understanding of communities which has supported the uptake and adaptation of preventive measures against the coronavirus in most rural areas.

Mid-2020, as the COVID-19 pandemic reached northern Kenya, it was impressive to see how quickly the now trained health workers and their communities adapted to the situation to control the virus with such flexibility screening more than 42,000 people. The response demonstrates the positive impact of skilled care and increased education at a community and primary care level. Leaves one to wonder if the acceptability of the drastic preventive health measures would have been the same if it weren’t for the training of local healthcare workers.

Whatever it takes: build back stronger healthcare systems for all

This year’s World Health Day comes against a backdrop of an overstretched and near-collapse healthcare system and overwhelmed health workforce that has endured the frontlines of a year-long pandemic that has ravaged all nations indiscriminately. Amidst the pandemic’s peak in Africa, local health workers, in particular, are exemplifying persistence and resilience in times when healthcare delivery to remote areas was even more challenging. Looking at how communities are coping in the times of the pandemic, we learn how community health workers are instrumental in providing primary healthcare services and supporting community awareness in far-flung areas. Witnessing adaptation of localised inventive solutions in these health-challenging times speaks volumes on the importance of bringing onboard communities to support access to healthcare to their communities.

As António Guterres, UN Secretary-General notes, the COVID-19 crisis has indeed revealed how unequal our societies are, therefore as we recover from the pandemic, we must implement policies and allocate adequate resources (both financially and human) so all can enjoy the same health outcomes. It is evident that the assurances of access to community health — including maternal health and other preventable diseases in particular — will bring many benefits. As we grapple with the burdening outcomes of the pandemic, this too could be an opportunity for us to address the other equally pressing healthcare challenges facing our communities and work towards securing adequate access for all.

The deployment of 50 UN Volunteer healthcare workers in 2020 under the Joint Devolution Project to 14 counties at the onset of the COVID-19 pandemic in Kenya, was significant in boosting the capacity of health facilities serving the underserved, rural, and marginalised communities. Photos: UNDP Kenya/Jonhson Muchiri

Ensuring healthy lives and promote well-being for all at all ages is a critical foundation to all the 17 Sustainable Goals. For us to truly attain SDG 3 — good health and wellbeing as part of the larger spectrum of sustainable development, we must then innovate how we implement the provision of healthcare particularly its access for all. We must also double up and continue our support of community health workers by leveraging local knowledge and insights and matching this with the right set of tools, including effective support and strengthening of the link between those who live isolated and the general healthcare referral system. Additionally, enabling the networks and expertise of community healthcare workers and volunteers through structured processes such as the UN Volunteer programme is consequently paramount and could be another way of ensuring communities especially those in the furthest areas have an equal chance to enjoying healthcare services. As we saddle back on the decade of action with the aim of accelerating the delivery of the Sustainable Development Goals by 2030 — we cannot do this without good health as a priority and our community health workers are the key to reaching those who are the furthest left behind.

In #Kenya, UNDP works with the Government and communities towards inclusive and sustainable socio-economic and human development. https://www.ke.undp