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Why digitising CHPs could be key to universal health

Members of a youth group in Bangladesh slum in Mombasa go for a community outreach program for reproductive health. ©Jonathan Torgovnik/Getty Images/Images of Empowerment

This article was first published in Nation on October 26, 2023 and has been crossposted here with their permission. 

The latest Mashujaa Day marked a momentous milestone on Kenya’s ambitious journey to universal health coverage (UHC) as President William Ruto’s unveiled 100,000 community health promoters (CHP) amid an expo showcasing health technologies and innovations.

That could professionalise a national CHP cadre by equipping, digitising, and remunerating this critical level of the healthcare system to revolutionalise primary healthcare delivery. Health policymakers and decision-makers must capitalise on the provision of mobile phones to CHPs and the efforts by the government and its partners to develop a unified, national CHP data platform by using the statistics to target, track and boost need-based service delivery.

CHP programmes will progressively shift the focus from curative to promotive and preventive care. These are a proactive approach to health promotion and vital component of UHC. CHPs are at the frontlines of community health and are critical to county governments’ health strategies. But they are often unpaid, lack adequate resources, or unengaged.

In September 2021, IDinsight partnered with the Meru County government to survey more than 700 CHPs to provide officials with data that could better direct efforts and resources toward a stronger CHP programme. In it, 96 percent of the CHPs cited a lack of financial support as the main challenge for the role, followed by insufficient supplies (64 percent).

Asked which drugs or supplies would make their work easier and more efficient, more than half of the surveyed CHPs pointed to blood pressure machines, glucometers, and mobile phones with more than 40 percent citing thermometers and over-the-counter medications such as painkillers. Many of these items are now included in the CHP kit but more needs to be done to fully leverage the capacity of CHPs to transform health outcomes for all.

Digitisation and deployment of the new electronic Community Health Information System (eCHIS) will help CHPs to collect community-level data that can elevate the quality and expand the reach of the healthcare system.

That has the potential to inform more efficient allocation of resources; strengthen performance management and supportive supervision to ensure CHPs have the relevant training and feedback; and monitor the effectiveness of investments such as the CHP kits as an accountability mechanism to citizens, taxpayers and partners.

Past CHP efforts at data collection have led to successful identification, referral, and follow-up treatment for HIV, tuberculosis (TB), and malaria patients. A digitally enabled CHP cadre can identify early warning signs of impending disease outbreaks and public health crises, especially in remote areas.

But we cannot stop at the provision of mobile phones and data systems; let’s also ensure that this data is used for decision-making. This can be achieved by building, at all levels in the health system, data interpreting and interrogation capacity, developing decision-relevant dashboards and data visualisations, and increasing transparency in health budgeting, resource allocation, and prioritisation.

That will fully transform current investments and commitments in the health system into healthcare accessibility and equity across the nation.