Political Prioritization for Community Health Systems Strengthening: A Case of Nairobi Metropolitan Services Health Directorate, Kenya

The Nairobi Metropolitan Services (NMS) recognizes that for the Directorate of Health to be impactful and achieve its universal health coverage, primary health care, and sustainable development goals by 2030, the Directorate cannot undermine the contribution of the community health workforce.

Institutionalizing community health services in Nairobi County was a journey of several years that recently bore its fruits for the directorate of health services and the community health workforce. The County is among the few in Kenya with a legal and policy framework for governing community health, having launched the Nairobi City County Community Health Services ACT, 2019. 

The occasion was graced by the Cabinet Secretary of the Ministry of Health, Honorable Mutahi Kagwe who was accompanied by senior officials from the Ministry of Health, and the National Assembly, the County Executive Committee Member for health, and other senior members of the Nairobi Metropolitan Services Health Directorate, and health development partners. The launch of the ACT of Parliament and the presence of key decision-makers at the national and county level indicated that community health advancement is top of the county’s priorities.

What does a legal framework for community health services mean for the directorate? 

1. Clear delineation of community-based health services
2. Enhance coordination of community health services
3. Improved community engagement and social accountability
4. Sustainable financing for community health 
5. Ensuring the rights of community health volunteers and community health personnel are protected includes health and safety, training and development, and stipends payment.

What does this mean for the county community health workforce?

Overall, the process paved the way for key policy and decision-making concerning the coordination, development, management, and supervision of the community health workforce. Mainly the directorate will be in a position to:

1. Finalize the vetting, verification, and registration of the community health volunteers in the Kenya Health Information System (creating a registry for community health volunteers)
2. Implementation of the community health volunteer monthly stipends, therefore impacting workforce motivation 
3. Development of the community health services costed implementation plan anchored in the community health services ACT, 2019, the National Community Health Strategy 2020-2025, and the National Community Health policy 2020 2030. 

What were the critical success factors in this process?

1. A strong political will from within and without the health directorate to have a sustainable community health services unit in the health directorate
2. Alignment of community health services to the national community health policy and strategic plan and the devolved health care services function
3. A community health champion who’s a member of the County Assembly – Health Committee, Honorable Peter Warutere. The champion took time to study and understand community health services’ role and need in advancing primary health care and universal health coverage goals for the county. With a clear understanding, the champion led the process of bill drafting and other processes before being enacted into law.
4. The unrelenting advocacy efforts by the health directorate leadership to have a legal framework for community health services
5. The community health volunteers’ contribution to response strategies for COVID-19 demonstrated that the community health workforce cannot be undermined in the fight against disease, especially in preventive and promotive services.  The community health workforce provided timely services, especially at the community/household level. This is evidence enough that to advance universal health coverage and primary health care goals, the community health workforce is catalytic in improving the results and outcomes of the efforts made.
6. Active multi-stakeholder engagement, including county and national health government officials, county assembly-health committee members, health development partners, and community participation through public hearings

What has happened since the Community Health Services ACT launch in 2019?

Guided by the national community health policy and following the launch of the Nairobi City County Community Health Services ACT, 2019, the milestones so far towards a motivated community health workforce are:

1. Vetting of 7460 community health volunteers; all of them are actively engaged in the 7460 community health units
2. Approval of the community health volunteer (CHV) monthly stipend by the NMS Human Resources Management Advisory Committee
3. Automation and rollout of the CHV monthly appraisal tool
4. Three Sub Counties  rolled out the electronic Community Health Information System through the training of community health assistants (30), who will cascade the training to all CHVs in their respective sub-counties
5. Roll out of the community health savings and loans associations, a pathway to sustainable financing for community health. The community health unit’s membership forms the associations.
6. Training of community health volunteers in nurturing care, a four-module training package aimed at building the capacity of CHVs in good health and adequate nutrition, child safety and security, child development and responsive caregiving, and giving children the opportunity for early learning
7. Training of trainers in community health committee curriculum in all 10 Sub Counties who will then train 280 community health committee members
8. Reactivation of COVID-19 campaign. All CHVs trained in social mobilization through a blended learning approach (face-face, virtual)

The article was written by June Musau, County Engagement and Support Coordinator at the Financing Alliance for Health