The context of CHWs in Kenya was similar to most: Various CHW Cadres, Various Sub specialties, Various Abilities, All non-paid, only career path limited to hired as assistant to certified private provider or support staff to government clinic
KEPH introduces an additional level of governance at sub-location level
Community Strategy better than what there was previously. However the failure to include care groups a missed opportunity.
Transcript of "Kenya Chw Plan"
Kenya Essential Package for Health (KEPH)-Community Strategy Core Fall Meeting September 15, 2010 Lessons from Kenya
Ministry of Public Health and Sanitation: Essential Health Package <ul><li>Kenya’s second National Health Sector Strategic Plan (NHSSP II – 2005–2010) defined a new approach to the way the sector will deliver health care services to Kenyans – the Kenya Essential Package for Health (KEPH). </li></ul><ul><li>KEPH introduced six life-cycle cohorts and six service delivery levels. </li></ul><ul><li>One of the key innovations of KEPH is the recognition and introduction of level 1 service, which are aimed at empowering Kenyan households and communities to take charge of improving their own health. </li></ul>
KEPH: Life Cycle Cohorts and Levels of Care <ul><li>§ Pregnancy and the newborn (up to 2 weeks of </li></ul><ul><li>age) </li></ul><ul><li>§ Early childhood ( 2 weeks to 5 years) </li></ul><ul><li>§ Late childhood (6–12 years) </li></ul><ul><li>§ Youth and adolescence (13–24 years) </li></ul><ul><li>§ Adulthood (25–59 years) </li></ul><ul><li>§ Elderly (60+ years) </li></ul>Tertiary Hospital Secondary Hospital Primary Hospital Health Center/ Maternity Homes Dispensary/ Clinics Community: Village/ Household/ Families/ Individuals
The KEPH Community Strategy Approach <ul><li>Establishing a level 1 care unit (CU) to serve a local population of 5,000-10,000 people with a CHC. </li></ul><ul><li>Instituting a cadre of well trained Community Health workers (CHWs) who will each provide level 1 service ( for all cohorts) to 20 households. </li></ul><ul><li>Supporting every 25 CHWs with a Community Health Extension Worker (CHEW). (NEW PAID STAFF) </li></ul><ul><li>Ensuring that the recruitment and management of CHWs is carried out by village and facility health committees. </li></ul><ul><li>Strengthening health facility–community linkages through LEVEL ONE SERVICES </li></ul>
Kenya Administrative Structure at District level COMUNITY UNIT LEVEL FACILITY LEVEL SUB-LOCATION 2 VILL VILL VILL VILL VILL VILL SUB-LOCATION 1 VILL VILL VILL VILL VHC LEVEL VILL VILL VILL VILL VILL VILL SUB-LOCATION 3 DISTRICT LOCATION 2 LOCATION 5 DIVISION 1 DIVISION 2 DIVISION 4 LOCATION 1 LOCATION 4 LOCATION 12 LOCATION 3 DIVISION 3 VILL VILL VILL VILL SUB- LOCATION 36 VILL
Comparison before and after Community Strategy in Kilifi District AFTER COMMUNITY STRATEGY: 36 Paid CHEWs, 36 CHCs, 900 unpaid CHWs in 367 Villages and 367 VHC BEFORE COMMUNITY STRATEGY: 14 Paid PHTs, 1555 unpaid CHWs in 367 Villages and 367 VHC Sublocation: 36 Each sublocation to be managed by a CHC facilitated by a resident CHEW. Allows for Sub-locational /CHC Decision Making Currently 14 CHEWs available (1 for 3 CUs). Sublocation: 36 Previously Kilifi had 14 PHTs who were later called CHEWs No CHC. PHTs worked directly with FHC/VHC Villages: 367 Each village has VHC and this allows for VHC Decision making Villages: 367 Each village has VHC and this allows for VHC Decision making Households: 54,000 900 CHWs reaching 18,000 or 33% of households but addressing all 6 cohorts Households: 54,000 Caregroups: 1314 (in 331 villages) 1555 CHWs reaching 100% of households but addressing WRA and U5 issues
Major Differences/Threats <ul><li>CHEWs: The project had 14 PHTs staffing 12 facilities within the 4 divisions. So essentially there were 14 CHEWs alongside project front-line staff. For a population of 300,000 KEPH recommends at least 36 CHEWs. </li></ul><ul><li>CHWs in KEPH will reach about 33% of households which they will have selected from the entire community . It is not clear what equity criteria would be employed in selecting these households. Also CHIS limited to 33% of the households would not provide a complete picture. </li></ul><ul><li>CHWs in CS will provide polyvalent services directed as 6 cohorts unlike in KID-CARE. The technical training required will also be superior. </li></ul><ul><li>FHCs will continue to operate at the facility level may do more dispensary management. CHCs will usurp/re-inforce FHC role of governance </li></ul><ul><li>CS will have no care groups at the homestead and household level unlike KIDCARE. This will result to “unsupported” CHW led efforts at this level which could lead to burn-out. For example decision making using local data will be limited to CHW and this could affect local action.CHW retention may become a major issue. </li></ul>
The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports
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