By Lilian Otiso
In March the U.S. Agency for International Development (USAID) and the United Nations Children's Fund (UNICEF) hosted a vibrant international conference in South Africa. The rationale for the conference was that:
Advancing community health is central to achieving sustainable development and universal primary healthcare. The foundations of community health within the context of primary health care are increasingly recognized as crucial components of national policies and strategies to accelerate progress in health. We need to further integrate community health approaches into national and local health policy and systems in order to achieve the Sustainable Development Goals and the implementation of the new UN Global Strategy for Women's, Children's and Adolescents' Health.
Two staff from the USAID SQALE Community Health Program attended and Kenya sent a national delegation of sixteen staff from the Ministry’s Community Health and Development Unit, Nairobi, Kisumu, and Migori counties, USAID, UNICEF, AMP Health, Living goods, and the World Health Organization.
What we heard
The conference was a great opportunity to learn from other projects working on similar areas and to explore the evidence base. Much of the discussion focused on how we can implement community health strategies at scale. It was agreed that these community systems should be embedded both in primary care and in the community through various engagement mechanisms. There was a call for the creation of community health systems which are country led and owned by the sub-national health system such as in districts, this included the creation of learning and accountability mechanisms at this level.
We heard that many challenges in community health systems were shared across contexts – for example in supervision, referral, and supply. Furthermore, many programs are reliant on donor funding and there is a need to make the investment case for community health systems. Questions remained about how national governments can best support this process.
When it comes to equity and accountability two main issues arose 1) that there was a need to better understand and respond to gender considerations in community health programs and 2) that we need to strengthen community health and improve resilience in emergencies and fragile contexts. There was an agreement that community empowerment is key, not just the empowerment of a few individuals.
The conference was a great opportunity to spend time strategizing with the Kenyan delegation and we returned home with updated plans on how we can better work together. Some of our priorities will be seeking to ensure that all counties are implementing community health programs in line with national standards (including ensuring gender equity), ensuring that decision makers have access to the most relevant evidence at the right time, thinking through how to strengthen community engagement, participation and accountability.