1. LEADERSHIP, MANAGEMENT AND GOVERNANCE FOR COMMUNITY ENGAGEMENT IN HEALTH DEVELOPMENT & SERVICES By Prof. MIRIAM K. WERE Medical Doctor & Public Health Specialist Laureate, Hideyo Noguchi Africa Prize by JAPAN. Community Health strategy Goodwill Ambassador, Kenya; Member of Champions for HIV-Free Generation, Africa; Queen Elizabeth II Gold Medalist in Public Health. ON THE OCCASION OF THE THE FIRST NATIONAL CONFERENCE ON HEALTH LEADERSHIP, MANAGEMENT & GOVERNANCE BY THE HEALTH SECTOR MINISTRIES, KENYA INTERCONTINENTAL HOTEL NAIROBI, KENYA. 29 th January -1 st February, 2013. 1

2. 1. LOW LIFE EXPECTANCY IN AFRICA INDICATIVE OF POOR HEALTH STATUS 2

3. 2. POSITIVE LEAP FORWARD A LEAP FORWARD HAPPENS WHEN THE COMMUNITY LEVEL IS RECOGNIZED AS LEVEL 1 = THE FOUNDATION= OF THE NATIONAL HEALTH SYSTEM 3

4. 3. THE COMMUNITY LEVEL AS THE FOUNDATION OF THE NATIONAL HEALTH SYSTEMS VISION: PEOPLE LIVING HEALTHY AND GOOD QUALITY LIVES IN ROBUST AND VIBRANT COMMUNITIES THAT MAKE UP A HEALTHY AND VIBRANT NATION. MISSION: MAKING THE COMMUNITY HEALTH APPROACH THE MODALITY FOR SOCIAL TRANSFORMATION FOR DEVELOPMENT FROM THE COMMUNITY LEVEL BY ESTABLISHING EQUITABLE, EFFECTIVE AND EFFICIENT COMMUNITY HEALTH SERVICES IN COMMUNITY UNITS IN KENYA. 4

5. 4. ACHIEVEMENTS FROM COMMUNITY ENGAGEMENT IN THE KENYAN CONTEXT  Immunization has increased appreciably;  Diarrhea cases among children under two years have reduced;  More women using ANC services and giving birth with the assistance of skilled workers;  Increased latrine construction and use;  Increased use of safe drinking water through boiling or chemical treatment and spring protection; 5

6. Achievements observed in Kenyan CHS continued  Better case management e.g. of malaria and pneumonia  Increased uptake of contraception for child spacing and family size planning.  The strategy amended to accommodate emerging issues:- ⁺remuneration of CHWs, ⁺supply of information tool kits, ⁺medicine kits, ⁺maintenance of the competencies of CHWs and their supervisors, the CHEWs. 6

7. 5. RECOMMENDATION FOR COMMUNITY ENGAGEMENT IN THE DEVOLVED HEALTH SYSTEMS 5.1.ESTABLISH THE 3-CADRE TEAM IN EVERY COMMUNITY IN THE NATION :  COMMUNITY HEALTH WORKERS (CHWs); For giving services to people in the community.  COMMUNITY HEALTH EXTENSION WORKERs (CHEWs); For managing and supportive Supervision of CHWs.  COMMUNITY HEALTH COMMITTEES For providing Leadership and Governance oversight at the community level. 7

8. 5.2 MAKE CLEAR TO EACH COMMUNITY WHICH HEALTH FACILITY IS THE LINK HEALTH FACILITY TO THE COMMUNITY THE COMMUNITY LINKAGES TO THE NATIONAL LEVEL HFC = Health Facility Committee CHC = Community Health Committee HFC County District Nation al Level 2 Level 1 Each served by a CHW Community Unit with CHC Village 1Village 2 Village 3 Village 4 e.t.c Households in the CU 8

9. 5.3 ESTABLISH IN EVERY DISTRICT THE DISTRICT FOCAL TEAMS FOR CHS (DFTs FOR CHS) These DFTs for CHS are to be dedicated to providing oversight and supportive Supervision to all the CUs in the district to ensure successful community engagement. 9

10. 5.4 ESTABLISH IN EVERY COUNTY COUNTY FOCAL TEAMS FOR CHS (CFTS FOR CHS). These County Focal Teams for CHS (CFTs for CHS) are to be dedicated to providing oversight and supportive supervision to DFTs for CHS. 10

11. 5.5 ESTABLISH AT MINISTRY OF HEALTH HEADQUARTERS THE DEPARTMENT OF COMMUNITY HEALTH SERVICES Transform the current Division of Community Health Services into the Department of Community Health Services in the HQ of the Ministry of Health in order to have sufficient staff to provide national oversight and supportive Supervision to the 47 CFTs for CHS and guide acceleration of the implementation the CHS to every sub-location (Community Unit) in the country. Specifically, the Department will:- a) Guide the cadre mix and numbers for the CFT for CHS & DFT for CHS; b) Supportive Supervision to the 47 CFTs for CHS; c)Monitor Performance of CFTs for CHS; d)Guide Operation Research to take place within each County; e)Facilitate sharing of Lessons Learnt in successful implementation of the CHS amongst the 47 Counties. 11

12. 5.6 DEVELOPMENT PARTNERS FOR THE COMMUNITY HEALTH STRATEGY : Both at the national level and county level there should be deliberate planning on how to reach out and solicit the involvement of development partners to support implementation, monitoring and periodic evaluation of the Community Health Strategy. The development partners include the private sector in the Public-Private Partnership (PPP) context. 12