We cannot ignore community health workers in UHC agenda: Githinji Gitahi
By Lilian Kaivilu
As the country Kenya launches UHC pilot project in the four counties, finances, human resources for health and sustainability of the programme are some of the key concerns in the pilot phase. I spoke to Githinji Gitahi, co-chair of the UHC2030 Steering Committee, on how the country should prepare for this phase…
In the recent years, Kenya has experienced shortage of health workers at all levels of healthcare. Should this be a concern as the country launches UHC?
No country can say they have enough health workers for UHC. The latter is a continuous thing because populations are changing and there is demographic shift of diseases. So the question is what can offer with the health works we have as a starting point. We have to start UHC and then start building the journey. We cannot wait until we have enough health workers. We need to recognise that we do not have enough of them then put in place measures to ensure we have adequate numbers as we continue implementing UHC.
Having joined other lower middle class economies after rebasing her GDP in 2015, Kenya is likely to see reduced donor funding in the health sector. How should the country prepare for this by 2030?
The country currently receives about $900m from donors. The rest of the money comes from the government and the people paying from their pocket. Therefore, the country needs to see how to convert the out-of-pocket expenditure into premiums through the National Hospital Insurance Fund (UHC) so that people can access health without worry. We should aim to reach a minimum of 15% of total budget being allocated to health by 2030.
As the country launches UHC pilot program this week, what will be the role of community health workers in this exercise?
Community health workers are the foundation of a good health system and if we do not build a good foundation, then everything else is going to be weak. This is because these are the people who ensure that households have toilets, dispose rubbish in the right manner, have hand washing facilities, trace TB patients and keep their data base.
Currently many community health workers offer their services voluntarily at the community level. Should their remuneration be a concern as the country launches the UHC pilot programme?
The challenge we have, is that for a long time we have failed to recognize, and put them on the payroll. This is because the partners have continued to support them. As Amref Health Africa, we are trying to put a bill in parliament to ensure that CHWs are integrated, regulated, remunerated as part of the health system. We, however, haven’t reached the tabling stage of the bill. But eventually the solution will be to formalize CHWs, know who they are, train, regulate and pay them. There is no other way out.
So what would be the solution in the meantime?
If we do not integrate the CHWs in the four plot counties, we shall fail. Out of the Sh3.9billion for the UHC pilot programme, there is some money that has been located to ensure that we have community health services fully integrated in the pilot. We do not have enough community health units that are operational in these four units. One of the key things is to operationalise these units in the four counties. Part of the money will also be used to train community health extension workers (CHEWs) who will lead the community health units.
Who pays for this training?
The community health extension workers are going to be trained through the medical training colleges. There is a curriculum that has been developed on the same. We are therefore asking the counties to pay for this training. The average cost of training one CHEW is Sh50,000 to Sh80,000 for a period of six to eight months.
What are some of the lessons that Kenya can learn from other countries in Africa that have tried to use the UHC model?
Rwanda is a good example. They have a system whereby about 90 of the people have a functional health card. The country has also formalised their community health services through cooperative societies and this way, they have achieved commendable progress in maternal health and child mortality. Ghana is also another place for us to learn. Initially, the country provided a very generous list of essential services. Consequently, they reached a place here they could not afford it and therefore they had to move back. If we promise more than we can offer as we launch our UHC, we may end this way. Let us start modest and then build up. We must not start by being over optimistic.