Community Health Worker’s Role in Bridging the Gap to Universal Healthcare in Rural Kenya




As the rhetoric for universal health coverage (UHC) intensifies in other parts of the world, Kenya’s shortage of healthcare providers in the public sector poses a threat to achieving the agenda.

The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. As stipulated by World Health Organization (WHO) this requires among other things a knowledgeable, skilled and motivated health workforce which Kenya still lacks.

In Kisii County for instance, there is only one health worker for every 2,148 people. It is one of the counties with the worst distribution of medical professionals according to a HIVOs funded 2014 study report titled “Where Is Your Doctor?”

The maldistribution of employed health-care workers between urban and rural areas exacerbates inequitable health-care provision including hindering goals for rural primary health services and for the prevention and treatment of HIV/AIDS infections in rural areas; this is a according to a World Health Organization bulletin titled: The impact of an emergency hiring plan on the shortage and distribution of nurses in Kenya: the importance of information systems.

Staff imbalances in the rural workforce is contributed by individual preferences for particular working and living conditions, the desire for professional opportunities not typically found in remote areas, financial incentives and weak deployment practices.

Despite the challenges in the healthcare human resource, Community Health Workers (CHWs) have a key role to play in accelerating the progress towards UHC in Kenya and sort of bridges the human resource gap.

Even though CHWs cannot substitute the highly skilled health workers’ role, Community health workers are trusted members of the community who are trained to provide basic primary healthcare services to their community members.

WHO puts the role of the CHW in this perspective: "Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers."

In Kisii County, a region with the one of the worst healthcare distribution of professionals, one Nduku Mayaka wakes up every morning armed with an assortment of health supplies that he will use to identify and address important health issues, particularly of young children and pregnant women in a couple of households within his sub-location to discuss.

Mayaka is one of the 45 community health workers who serve approximately 1,000 households who live in Nyamira Township. Each one of them serves approximately 20 households within the sub location.

In order to offer reliable health promotion information and services, a community health worker undergoes training on the wider concept of community health services in line with Kenya Essential Package for Health (KEPH). The training focuses on varied areas including: community strategy, pillars of primary health care, community mobilization strategies, community based health information system (CHIS), basic information on modern family planning methods, contraceptive and HIV Testing and counselling.

According to Joel Milambo, Community Focal Person, Bondo Sub-county, the trainings are key to enhancing a CHWs capacity to proficiently engage communities to strengthen facility-community linkages in promoting sustainable demand and utilization of quality healthcare services.

Is there any evidence to assert that CHWs can deliver?

CHWs provide life-saving, culturally acceptable health-care services that reduce preventable causes of maternal and child mortality.

Amos Onderi, the Program coordinator of APHIAplus Health Communication and Marketing Program, a USAID funded program that seeks to enable the government harness the skills of private players in health sector sees community health workers as inevitable change agents in community-based primary health-care reforms.

Onderi reports that in 80 private facilities drawn from 15 counties of the western Kenya region he has used Huduma Poa affliated CHWs who have conducted 1,976 door to door visitations including reaching out to women in church, markets, farms, barazas; and women groups with integrated reproductive health information within the last three months.

This has resulted to 2,062 clients receiving family planning services, 1,537 screening for cervical cancer and 1676 clients testing for HIV numbers that he says could not be attenble without using community health workers as referral agents to hospitals.

CHWs can also help to reduce the cultural barriers to uptake of family planning services in rural Kenya. Being locals of their work areas they understand the social dynamics of their communities and can effectively carry out counselling and distribution of condoms and birth control pills with limited resistance from members of the community.

WHO and UNICEF state that CHWs deliver integrated community case management of malaria, pneumonia, diarrhoea, and malnutrition which are leading killers of children younger than 5 years. CHWs also provide a vital link between communities and health facilities.

There is ample evidence to show that they can fill the gap of shortage of health personnel in Africa.

"We have seen in Rwanda the ability of community health workers to improve public health and believe that this initiative can serve the cause of public health throughout Africa. This campaign will support many ongoing public-private partnerships, UN initiatives, and African Union efforts to meet the health Millennium Development Goals."

Rwandan President Paul Kagame was quoted by an online news website (  saying, “Use of community health workers is something we have had experience with and we have seen good results.”

With more than 45,000 CHWs and less than 1000 doctors, Rwanda has recorded improvement in health outcomes with maternal mortality ratio dropping by 60% over the past decade and deaths from HIV, tuberculosis, and malaria each dropping by about 80% over the same period. Under-5 mortality has also been cut by 70% since 2000 and introduction of the community health workers.

If Kenya invests in implementing the community strategy using CHWs in every county I believe that they will help the country reach UHC sooner than anticipated. I believe strongly that this is the way to go.