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Evaluation report

2010 Kenya: Community Strategy Evaluation



Author: JOHN PAUL OYORE Institution: PROMOTIVE HEALTH CONSULTANTS Partners: DIVISION OF COMMUNITY HEALTH

Executive summary

 

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Background:

The Ministry of Public Health and Sanitation (MoPHS) adopted the Community Health
Strategy in the year 2006 to actively engage the communities in managing their own
health (MoH, 2005). The strategy aims at improving health indicators by implementing
some very critical interventions at the community level. The overall goal of the
community strategy is to enhance community access to health care in order to improve
productivity and thus reduce poverty, hunger, and child and maternal deaths, as well
as improve education performance across all the stages of the life cycle and the
government has achieved 7% coverage to date. Non-governmental and community
based organizations (CBOs) have also been involved in the implementation of the
strategy at grass-root levels.

Purpose/Objective:

The main purpose of the evaluation was to establish the effectiveness and relevance of
the community health strategy as well as take cognizance of the lessons learnt with
regard to empowering communities in taking charge of their own health. The
evaluation utilized a triangulation approach in data collection. The main data collection
method was a household survey in which 3884 respondents were interviewed. The
respondents were randomly selected from 21 of the 64 districts where the community
health strategy has been implemented by the Global Alliance for Vaccines and
Immunization (GAVI).

Methodology:

Qualitative data was collected through Focus Group Discussions (FGDs) with
Community health workers and beneficiaries. In addition, more data was collected
through Key Informant Interviews (KIIs) with stakeholders and partners at District,
provincial and national levels. In this regard 40 FGDs were conducted and 120 KIIs
carried out with District Health Management Team (DHMT) members in the selected
districts and an additional 10 other KIIs with partners and MoPHS at the national level.

Findings and Conclusions:

The evaluation established that the services currently being offered by the Community
Strategy at level one in Kenya under the hygiene and sanitation such as water safety,
food hygiene and solid waste disposal among others are relatively more
comprehensively covered as compared to the other components.

Results from KIIs with CHEWs and FGDs with CHWs showed there was an established
link between the community and the health facilities. This was mainly through the
coordination between PHT-CHEW and the CHWs who participated in identifying cases
of illnesses at the community level and referring them to the health facilities. After
interviewing the CHEWs and CHWs as well as holding discussions with the
beneficiaries in the CUs, it was revealed that the community was increasingly becoming
aware of their rights to quality health care. However community members were not
adequately empowered to demand for the services and there was lack of clear
structures for addressing their grievances.
It was established that, the community based health information management was not
very effective. However, not all CUs were introduced to the CBHIS and some data tools
were developed by NGOs in their specific programmes. Information collected included
the mothers referred for ANC, exclusive breastfeeding, children receiving vitamin A,
ART defaulters among others.

Recommendations:

The training of CHWs should be re-designed and delivered in phases (several short
training modules spread over time) covering more content. Such multi-phased
training will increase the retention rate because the CHWs will anticipate further
training and probably develop a career path. This approach has worked very well in
Malawi and successful participants have been recommended for further training.
• There is a need for advocacy to ensure that all partners/ministries of government
adopt the community unit as the unit for all developmental work to ensure
synergy
• There is a need to ensure that if trained health workers are to be CHEWs working
with the community health strategy, then their functions should be included in the
basic/pre-service training and they should only be deployed for this work.
Otherwise there is need to develop a new cadre of workers specifically for CS as has
been the case in Ethiopia.
There is need for production and dissemination of key health messages of CS
targeting high impact interventions. These should include effective communication
mechanisms through visual and audiovisual channels.
• There should be improved staffing of the facilities where CUs are linked in order to
strengthen referrals and linkage systems especially taking into consideration the
spatial distribution and population density. This will improve support supervision
from CHEWs to CHWs during their community work.

Lessons Learned (Optional):

The main lessons learnt from the evaluation are as follows;-
• Participation of community members in strengthening health systems elicited grass
root acceptance, support and sense of ownership. This resulted in increased demand
for health services at level 1 therefore improving health of the target population.
• Active supervision and linkages forged between DHMT, CHEWs, CHWs, and CHC
played a key role in the sustainability of the programme.
• Creating community demand for health services by government and partners must
be matched with the availability of improved services within health facilities.
• A comprehensive, integrated approach to a multidimensional health programme
helps ensure that communities ultimately access the services they need.



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