As Kenyans commemorated Mashujaa Day on October 20th–where we celebrate the heroes of our nation’s past–we were met with hope for the future through President Ruto’s launch of Universal Health Coverage (UHC). After a decade of planning and commitment-making, Kenyans will now realize the promise of health for all–meaning high-quality essential health services available to everyone, without financial hardship.
Strong community health systems are at the center of achieving health for all. The launch of UHC therefore brings significant changes to how health services are provided at the community level, through lower level facilities, and through community health workers (CHWs).
Lwala has long been committed to strengthening the community health system, professionalizing CHWs, and enabling community accountability to improve health. We applaud President Ruto and the government for passing programs and laws that will transform health care for Kenyans, including efforts to pay and equip 100,000 CHWs across Kenya, as well as legislation on primary health care and financing for health facilities.
Recommitting to professionalize community health workers
CHWs are at the forefront of primary and community health. Yet they have remained underpaid, underequipped, undervalued, and often deprived of opportunities for training and professional development. Lwala is committed to reverse this status quo, and we’ve worked with our community health partners to offer solutions rooted in programmatic experience, research, and the priorities of CHWs themselves. During last year’s election, we advocated for CHW payment to be included in party manifestos, and we met with the new administration post-election to develop a way forward. Earlier this year, the national and county governments of Kenya agreed to a cost-sharing system to pay CHWs a monthly stipend, as well as provide them with health insurance.
These commitments were solidified in September at a national launch event, where the President kicked off the distribution of standardized kits to equip 100,000 CHWs with supplies and medications needed for daily services. This historic moment marked a turning point and the beginning of a new era for community health in Kenya, where the focus of health care widened its lens to include prevention, promotion, and protection delivered by CHWs at the household level.
“Our advocacy efforts have always been geared toward achieving proCHW principles. It’s a great milestone that CHWs are now recognized as health care workers, and we now have county and national governments’ commitment to pay them. Our next step is to ensure that they are paid consistently and on time.”
- Doreen Baraza Awino, Director of Health Systems Strengthening
These efforts align with the rollout of the electronic Community Health Information System (eCHIS), a new digital platform owned by the national government that was developed to digitize Kenya’s community health workforce and advance UHC. Using the eCHIS platform, CHWs can manage caseloads from their phones, and information can be aggregated at the local, county, and national levels to be used for decision-making. Lwala was a key partner in developing eCHIS at the national level, and we are also supporting its rollout in Migori and eventually 4 additional Kenyan counties.
Legislation to advance Universal Health Coverage
Ahead of the UHC launch on October 20th, President Ruto signed additional bills into law, including two that will significantly impact community health:
Primary Health Care Act: This law further strengthens the role of CHWs within the formal health system–alongside our partners at Community Health Units for Universal Health Coverage (CHU4UHC), Lwala championed specific provisions related to CHW professionalization and payment, including a memo we presented to the Senate Committee on Health. Additionally, the law establishes Primary Care Networks (PCNs), which use a “hub and spoke” model that connects a subcounty hospital to multiple health centers, dispensaries, and community health units. These networks share information and resources, pool commodities, and strengthen referrals.
By improving the quality of care delivered at lower level health facilities, clients can have the confidence to seek care closer to home. This model was introduced in 2021, and the 18 implementing counties reported improved integration of service delivery, better teamwork among different cadres of health workers, and stronger monitoring and evaluation
Facility Improvement Financing Act: When health facilities in Kenya want to improve quality of services, they often face a critical roadblock: lack of funds. Under the previous law, all money earned by health facilities had to be turned over to the county treasury for redistribution. The new Facility Improvement Financing Act enables health facilities across the country to keep the money they earn from patient fees and other sources and reinvest it as they see fit, including in community health. This is a significant win for Lwala’s strategy to support counties to adopt community-led health, as Health Facility Management Committees will have much more control over how money is spent to improve quality of care.
It takes a village
In 2020, Lwala and our partners co-founded CHU4UHC to advance community health and ignite system change for UHC–from professionalizing CHWs to supporting community-led accountability. The coalition brings together community health actors in Kenya to work alongside and support the Ministry of Health.
Together, we have reiterated the same message: pay CHWs, give them the tools, training, and support to do their jobs well, and include community priorities in health decision-making. This drumbeat is paying off–the policies and strategies we developed with the Ministry of Health laid the groundwork for what we’re seeing today. Lwala will continue to walk the journey toward UHC with our government, our partners, and most importantly, our communities.
“The evidence that we are generating from the work we do is solidifying the proof that community health does change health outcomes. We have a larger responsibility to community health and to the CHWs who make this work happen. We will continue to scale the impact that we have achieved in Migori County with the ultimate aim that we can see progress in community health outcomes in Kenya.”
- Julius Mbeya, Co-CEO