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Published: August 3, 2022

Migori County passes landmark legislation to pay community health workers

In a watershed moment for community health, on August 2nd, 2022, Migori County launched new Community Health Services (CHS) legislation. Signed into law by Governor Okoth Obado, it marks a bold and progressive step by the county government to improve the health of 1.1 million people. It also solidifies the county’s commitment to community health workers (CHWs), who are the backbone of the health system. Lwala has been a proud partner to the Migori County government in making this law a reality.

“Today marks a major milestone in our health care system, as we demonstrate the commitment of Migori County to community health services.”
- Governor Okoth Obado during the launch of the Community Health Services legislation

CHWs play a central role in caring for their communities–they are a trusted source of information, and they provide critical health services that lessen the burden on health facility staff and referrals. But when CHWs are not professionalized–paid, trained, supervised, and digitized–they have less capacity to provide these services. Indeed, only a handful of CHWs in Kenya are salaried, and many do not have supportive supervision and consistent training. Lack of payment means fewer household visits and higher turnover, and lack of training and supervision means lower quality care. When county governments pass policies and budgets that formalize the role of CHWs, they unlock the door for better and more accessible health services. 

In 2018, Migori County began paying stipends to its CHWs, becoming one of the few counties in Kenya to do so. The CHS legislation will further strengthen this commitment, reinforce the importance of community leadership in health, and accelerate commitments to achieving Universal Health Coverage.

  • Strengthen the community health workforce: This new law paves the way for professionalizing CHWs. It outlines the process for recruiting new CHWs, sets standards for their training and accreditation, emphasizes the importance of supportive supervision, and commits to paying CHWs. 
  • Center community leadership in health: While many governments plan for health care in a top-down manner, Migori’s new law centers communities in planning, leading, and evaluating health services–and in holding health systems accountable. The law sets guidelines for strengthening community health committees, which are elected groups mandated to represent their communities’ priorities for health. 
  • Accelerate Universal Health Coverage: Kenya has committed to reaching Universal Health Coverage–or health care for all–by 2025. But achieving this goal can only be reached when CHWs are equipped to deliver high-quality services to the hardest-to-reach communities. This law brings Migori County closer to ambitious Universal Health Coverage goals. 

For nearly a decade, Lwala has partnered with the Migori County Ministry of Health to strengthen community-led health. Lwala supported the development of the CHS legislation and provided technical assistance and research that informed provisions on CHW professionalization. 

Like any new legislation, its success lies in implementation. Lwala will continue partnering with the Ministry of Health in developing implementation plans, training CHWs and their supervisors, rolling out new digital tools, and establishing a comprehensive and up-to-date CHW registry. Lwala will also raise public awareness of the new law, and support communities to be involved in priority setting and accountability. Finally, Lwala will continue to work to ensure traditional birth attendants (TBAs) are not left behind–as trusted providers of healthcare for generations, TBAs can transform women’s health when incorporated into CHW cadres.  

As we celebrate the passage of Migori County’s legislation, a similar bill is being developed at the national level. Lwala is working with Communities Health Units for Universal Health Coverage (CHU4UHC), a coalition of community health actors in Kenya, to support its development and passage, ultimately ensuring that professionalized and paid CHWs become the national norm.

“This is a big milestone. Community health workers are the backbone of health in this country and in Migori. We are so proud that this law recognizes all the work that they do for our communities.”
- Doreen Awino, Lwala’s Health System Strengthening Director at the launch event in Migori

Agency, health, and wholeness of life.

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