The USAID SQALE Community Health Services Program is a three-year project to improve maternal and child health through a focus on community health systems in Kenya.

Facing a challenge

Many women die or become disabled because they fail to access the recommended health services – both antenatal and when they give birth. It is estimated that 58% of pregnant women attend four antenatal care visits and 61% deliver in a facility. The 2014 Kenya Demographic and Health Survey estimated that under-5 child mortality is 52 per 1000 live births and only 68% of children have received complete vaccination. In some rural areas and among poorer communities in cities the situation is worse than the average.

A complex rage of factors effect women and children’s access to services – these can be related to income, the distance from health care centres, poor roads, and the cost and availability of transport, and a lack of decision making power in the household. These challenges can be compounded by poor health facilities, a lack of supplies, inadequately trained or poorly motivated staff and lack of referral services. Community health systems and services have the potential to improve maternal and child health but they need support.

Supporting community health services

The Kenyan government and non-governmental organisations have made a commitment to community health. This work is carried out by Community Health Extension Workers who train volunteers, carry out HIV testing and counselling, deliver family planning immunization and child nutrition services, among other tasks. They supervise Community Health Volunteers who are chosen by the community.  Community Health Volunteers are responsible for 20 households and serve on a voluntary basis, carrying out home visits and reporting on a monthly basis. Although equipped to treat common ailments, their focus is primarily on health promotion and prevention.

These community health workers are the unsung heroes and heroines that provide a vital first link between the community and health services.

Kenya is on the brink of further scaling-up community health programs, but there are risks that rapid scale-up will compromise quality, equity, and sustainability of services.

A quality improvement approach

USAID SQALE supports this effort through a process of Quality Improvement that includes capacity building and community engagement. Our aim is to strengthen leadership and coordination at national, county and community levels by embedding a culture of quality improvement practice.

This will result in:

  1. Leadership and communities of Quality Improvement embedded at national and county levels resulting in strengthened coordination for improved community health programs
  2. Increased capacity of county decision makers to prioritize and budget for community health programs in an equitable manner
  3. Improved community health program performance in reproductive, maternal, neonatal and child health
  4. Stronger community engagement and increased community participation in decision making

We will begin work in Nairobi and Kitui Counties and then expand to a further two intervention counties and four control counties.