Community Health Workers in Abakore, Northeastern Province, Kenya stand with their health kits. Photo credit: Save the Children/Colin Crowley.

Save the Children is supporting a Community Health Workers training project in Abakore, Northeastern Province, Kenya. Each Community Health Worker is trained to assist their communities in issues related to general health, malnutrition, childbirth, and breastfeeding. Community Health Workers are then assigned 15-20 households each to which they make weekly visits in order to monitor malnourished children and pregnant and lactating mothers. The Community Health Workers act as a main source of health education and they serve as a link between the communities and government health facilities and services available to the community. They work to help mothers to give birth safely in health facilities and they also identify children who are malnourished and ensure that they receive proper treatment. They are also educating their communities on health and hygiene issues.

One of the Community Health Workers, Qayasa Dubo, says “We are in the best position to contribute to the health care of our communities because we are from the village, we know the context, we know the language, we know the mothers – and they listen to us more than they would any other person from the outside. I am a mother myself, so I have personal experience with women’s issues.”

Neonatal mortality rate  (per 1,000 live births) (2011) 27
Under-five mortality rate (per 1,000 live births) (2011) 73
Maternal mortality ratio (per 100,000 live births) (2010) 360
Number of doctors, nurses and midwives per 10,000 people (2010) 9.7
Births attended by skilled personnel (2009) 43.8%
Total expenditure on health as a percentage of gross domestic product (2011) 4.5%
General government expenditure on health as a percentage of total expenditure on health (2011) 39.6%

The National Health Insurance Fund (NHIF) in Kenya covers mostly formal sector workers: about 25% of the poor are estimated to have medical coverage. The burden of disease is overwhelmingly due to communicable diseases, with HIV/AIDS as the number one cause of mortality and morbidity; progress towards the health MDGs has been limited.

The availability of skilled health professionals is low and there is inequality in access, ranging from 20 to 80% from the richest to the poorest. Urban-rural inequities are also significant, particularly for access to physicians. The devolution process underway will give authority over HRH to the counties, which may lead to differences in availability according to county prioritization of resources. On a positive note, there is quite a high percentage of female physicians (approximately 1/3).

There is also evidence of good mechanisms for accreditation, regulation and licensing of the health workforce through the different professional councils, including requirements of continuous professional development for relicensing of physicians, nurses and dentists. However policy mechanisms, inter-sectoral collaboration and human resource information systems need to be strengthened to enable successful planning and management of the workforce.

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