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Published: March 17, 2023

Communities as change-makers: how strengthening community health committees creates lasting change

When it comes to improving health care, Lwala believes that communities should be in the driver's seat. “Many health programs are driven by donors and technical experts who don’t fully understand the local context,” says Doreen Awino, Lwala’s Director of Health Systems Strengthening. But no one can identify challenges and solutions better than communities themselves. Lwala’s goal is to unlock this community-led change–and community health committees (CHCs) are the engine.

CHCs are the link between their communities and health providers. Their role is to gather their community members’ concerns and requests related to health care, and then work with community health workers (CHWs), health facility staff, and other local leaders to improve services. In Kenya, CHCs are responsible for overseeing and strengthening community health–they hold the government accountable, ensure transparency in how resources and commodities are allocated, and elevate community demands in policy and budgeting processes.

Each community needs a strong CHC to represent their priorities. In Suna Rabour, a community located in Suna East Subcounty, Luke Lwanda recognizes the importance of his role. “The success of health care relies on the ownership of the community,” Luke says. “I’m motivated because I was chosen by my community to serve on our CHC.” This past year, Suna Rabour was one of many communities in Migori County to create, implement, and sustain their own community-led health solutions through CHCs.

Across Kenya, however, CHCs have historically been underutilized and undertrained. Lwala strengthens the ability of CHCs to plan, execute, and evaluate all local health initiatives. Our vision is that every community in Migori County has a skilled, trained, and equipped CHC to represent their priorities and advocate for better health.

“The success of health care relies on the ownership of the community. I’m motivated because I was chosen by my community to serve.”
- Luke Lwanda, community health committee member in Suna Rabour

In 2021, Lwala conducted Kenya’s first county-wide assessment of CHCs to understand which communities lacked representation–and to assess existing CHCs across six indicators that, together, demonstrate their level of functionality. Informed by interviews with more than a thousand CHC members, Lwala worked with the Ministry of Health to develop a National Community Scorecard. Launched in 2022, this scorecard is now a foundational tool for accountability–it jumpstarts a process where CHCs collect community input, and then share that input with CHWs, health facility staff, and local leaders to develop an action plan for change.

The CHC in Suna Rabour was one of the first groups to pilot the scorecard after being trained by Lwala. Dialogue with community members revealed a few key issues: they felt health workers weren’t responsive enough to their needs, they noted a lack of emergency referral services, and they raised concerns with consistent water and electricity at the health facility. “The scorecard helped us know our strengths and weaknesses,” says Jared Kaounde, Assistant Chief of Suna Rabour. “As chiefs, before we didn’t know we had a role to play in health–but because of the scorecard, we now do.”

“The scorecard helped us know our strengths and weaknesses. As chiefs, before we didn’t know we had a role to play in health–but because of the scorecard, we now do.”
-Jared Kaounde, Assistant Chief of Suna Rabour

Together, community members, health facility staff, and local leaders created an action plan. First, Suna Rabour introduced health facility outreaches and consistent community dialogues. Outreaches enable communities to receive services from facility-based health providers closer to where they live. Increased community dialogues, now held quarterly, provide ongoing space for feedback between the CHC, community members, and health workers. To close the gap in emergency referral services, Suna Rabour’s CHC coordinated with private car owners to provide emergency transport at reduced costs. With Lwala’s support, the CHC recently submitted a funding proposal to the local government to install a new rainwater catchment for the roof to collect water, as well as solar panels to reduce electricity blackouts.

The CHC's commitment has driven community ownership, sustainability, and improved health outcomes–and as word of improvements at the health facility spread, more people came for services. From 2021 to 2022 at Suna Rabour’s health facility, antenatal care visits increased 23%, family planning visits increased 60%, and skilled deliveries increased 62%.

Alongside the scorecard, Lwala supported the development of Kenya’s National CHC Curriculum, where we helped shape training standards and monitoring tools for CHCs. We also advocated for the inclusion of a module on resource mobilization, to build CHCs’ ability to fundraise for improvement projects.

Since the CHC Curriculum’s passage in 2022, we’ve trained 105 CHCs across Migori County, preparing them to engage in policy and budget advocacy, drive health initiatives, and mobilize the necessary resources. For example, in Kanyimach, a community in Rongo Subcounty, the CHC learned that during facility outreach events, pregnant women had to lie on the floor for abdominal examination. So they contributed resources and time to construct a bed at the outreach site, which has encouraged more women to seek care.

These success stories have been echoed across Migori County as CHCs strengthen their leadership roles. We recently conducted a second CHC assessment, and between 2021 and 2022, we saw a significant increase in overall CHC functionality. The assessment found, for example, a 94% increase in CHCs that develop annual work plans, a 48% increase in CHC involvement in CHW recruitment, and a 59% increase in CHCs that hold monthly meetings with CHWs to review health data for decision-making. In Rongo Subcounty, where Lwala has worked the longest, we saw the most significant progress. With Lwala’s expansion into additional Sub Counties, we expect to see other CHCs follow Rongo’s lead.

Centering communities as leaders and decision-makers–and not as beneficiaries–is the most sustainable way to improve health care. It’s also the most motivating. “A healthy community is a wealthy community,” Luke Lwanda says. “I feel good when my people are well.”

Agency, health, and wholeness of life.

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