---COMMUNITY HEALTH STRATEGY
1. Introduction to Community Health Strategy
Definition:
A Community Health Strategy (CHS) is a government-led initiative aimed at strengthening primary health
care through community-based health service delivery structures. It decentralizes healthcare to the
community level to promote preventive and promotive services.
Objectives:
Improve access to health services.
Increase community participation in health planning and implementation.
Strengthen linkages between communities and health facilities.
Support the attainment of Universal Health Coverage (UHC).
Background Information:
Rooted in the Primary Health Care (PHC) approach from the 1978 Alma Ata Declaration.
Supports Kenya Health Policy and aligns with Vision 2030.
Key Components:
Community Health Units (CHUs)
Community Health Volunteers (CHVs)
Community Health Assistants (CHAs)
Community Health Committees (CHCs)
Importance:
Empowers communities to take charge of their own health.
Enhances early disease detection and prevention.
Reduces burden on health facilities by managing minor illnesses at home.
Improves health data collection and accountability.
Case Example:
In counties like Makueni, CHS implementation has led to more facility deliveries, better immunization
coverage, and fewer maternal deaths.
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2. Community Entry Process
Definition:
Community entry is the process of establishing rapport and collaboration with the community before
starting health programs.
Steps:
1. Stakeholder identification (chiefs, elders, religious leaders).
2. Community sensitization (forums, barazas).
3. Needs assessment.
4. Consensus building.
Why It Matters:
Builds trust.
Ensures smoother program implementation.
Promotes local ownership.
Principles:
Respect for local culture.
Inclusive participation.
Challenges & Solutions:
Resistance: Use respected local figures.
Misinformation: Provide clear, accessible information.
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3. Determination of Community Unit Boundaries
Purpose:
To define the area each Community Health Unit (CHU) serves.
Factors Considered:
Population (~5,000 people/CHU).
Administrative boundaries.
Terrain and accessibility.
Process:
Participatory mapping.
Community discussions.
GPS and sketch mapping tools.
Importance:
Fair CHV workload.
Comprehensive service coverage.
Class Activity:
Students can simulate drawing CHU boundaries using a map of their area.
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4. Selection of Community Health Committees (CHCs)
Who They Are:
9–11 community-elected members representing women, youth, elders, etc.
Roles:
Supervise CHVs.
Mobilize local resources.
Represent community health interests.
Link CHUs to government.
Selection Criteria:
Literate, respected, available, willing to serve.
Training:
Leadership, governance, planning, and mobilization skills.
Support Needs:
Mentorship by CHAs.
Inclusion in health planning.
Discussion Prompt:
Why is community representation crucial in managing local health?
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5. Selection and Training of Community Health Volunteers (CHVs)
Who They Are:
Residents trained to offer basic health services to 100–150 households.
Selection Criteria:
Literate, community resident, good communication, willing to volunteer.
Training Areas:
Basic modules (10 days) on health promotion, hygiene, referrals.
Technical areas: HIV, malaria, nutrition, iCCM.
Roles:
Household visits.
Health education.
Referrals and reporting.
Motivation:
Non-financial (t-shirts, recognition).
Some receive stipends from NGOs or counties.
Challenges & Solutions:
Overwork: reduce ratio of households.
Dropout: create peer-support groups.
Visual Aid Suggestion:
Diagram a CHV’s weekly schedule.
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6. Household Mapping and Registration
Definition:
A census-like process where CHVs record every household’s location and health status.
Purpose:
Assign CHVs accurately.
Collect baseline health data.
Steps:
1. Draw maps with community input.
2. Allocate households (100–150 per CHV).
3. Record household demographics, sanitation, and health status.
Tools:
MOH 513 (household register).
GPS, sketch maps.
Benefits:
Identify vulnerable households.
Plan interventions more effectively.
7. Determination of CHU Services
Core Services Offered:
Health promotion (hygiene education, behavior change communication).
Disease prevention (immunization campaigns, deworming, vitamin A).
Maternal and child health (ANC visits, growth monitoring).
Nutrition education and home gardening support.
Water, sanitation and hygiene (WASH) sensitization.
Basic curative care (malaria, diarrhea, ARIs).
Referrals and follow-up of chronic/critical cases.
Factors Influencing Service Delivery:
Training and skills of CHVs.
Availability of job aids and logistics.
Health priorities of the region.
Supplementary Support:
Integration with schools and women/youth groups.
NGO support (drugs, transport, IEC materials).
Class Activity: Let students develop a mock list of health priorities and match them to CHU services.
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8. Monitoring of Community Health Units
Purpose: Ensure activities are happening, problems are addressed, and outcomes measured.
Who Monitors:
CHAs (primary supervisor).
Sub-county teams and stakeholders.
CHC via community feedback.
Monitoring Tools:
MOH 514, 515, 516.
Supervision checklist.
Scorecards and community dashboards.
Frequency:
Weekly spot-checks.
Monthly reports.
Quarterly review meetings.
Digital Tools:
DHIS2 for uploading community data.
Mobile tools (e.g., mUzima) in pilot areas.
Challenges & Solutions:
Incomplete tools → refresher training.
Delayed reports → motivate with recognition.
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9. Sustainability of Community Health Units
Pillars of Sustainability:
Community Ownership: Engaged CHCs and regular dialogue.
Capacity Building: CHVs/CHCs empowered with ongoing training.
Financial Support: Local government, partners, or IGAs.
Policy Support: County CHS plans and legal frameworks.
Income Generating Activities (IGAs):
Poultry, goat keeping.
Soap-making.
Table banking, merry-go-round.
Real Example: A CHU in Siaya County funds its outreach through sales of vegetables from a communal
garden.
Discussion Question: How do we balance volunteerism and sustainability?
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10. Reporting of Community Health Data
Purpose: Track progress, identify gaps, and inform health planning.
Data Collection Tools:
MOH 513: Household register.
MOH 514: CHV logbook.
MOH 515: Monthly summary.
MOH 516: Supervision tool.
Reporting Channels: CHV → CHA → SCHMT → CHMT → DHIS2 → MoH
Use of Data:
Identify disease outbreaks.
Track ANC/immunization coverage.
Guide supplies and interventions.
Limitations:
Paper-based systems can be slow.
Data falsification or underreporting.
Remedy:
Feedback meetings.
Data quality audits.
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11. Training of CHVs and CHCs
Training Needs Assessment:
Observe field gaps.
Interview CHVs and community.
Check missed targets in reporting.
Topics to Cover:
Communication skills.
Disease surveillance.
Basic curative care.
Mental health and first aid.
Training Methods:
Role-play and demonstrations.
Community-based mentorship.
eLearning (pilot in some counties).
Follow-Up:
Post-training supervision.
Peer coaching among CHVs.
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12. Establishment of CHU Annual Work Plans
Why Work Plans Matter:
Provide structure and goals.
Support resource mobilization.
Encourage accountability.
How to Develop:
1. Conduct community diagnosis.
2. Prioritize issues.
3. Outline activities.
4. Assign responsibilities.
5. Set indicators and deadlines.
Helpful Tools:
Logic framework template.
Sample annual work plan formats.
Class Task: Students should develop a sample 1-page CHU annual plan.
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13. Management of CHVs and CHCs Register
Why Maintain Registers:
Track active and inactive members.
Plan supervision and rewards.
Facilitate performance reviews.
Contents of Register:
Bio-data.
Training status.
Assigned households.
Attendance logs.
Activity: Design a register layout using Excel or Google Sheets.
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14. Evaluation of CHVs and CHCs Performance
Key Performance Indicators (KPIs):
% of household visits completed.
Accuracy and timeliness of reports.
Referral follow-ups.
CHC meeting attendance.
Evaluation Tools:
MOH 516.
Community scorecards.
Direct observation checklists.
Reward Systems:
Certificates and awards.
Public recognition.
Recommendation for advanced training.
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15. Community Health Assessment
Purpose:
Understand needs.
Design tailored programs.
Monitor change over time.
Tools:
Surveys.
Focus group discussions.
Transect walks.
Observation checklists.
Indicators to Look For:
Disease prevalence.
Maternal/child outcomes.
Sanitation and WASH access.
Tips:
Use simple language.
Involve local leaders and CHVs.
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16. Setting Health Agenda
Definition: Process of determining health priorities for action.
How to Do It:
Collect community views.
Prioritize high-impact and feasible issues.
Align with county plans.
Tools:
Problem ranking matrices.
Community dialogue tools.
Example: Top issues in a CHU: waterborne diseases, malnutrition, low ANC.
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17. Health Campaign Strategies
Strategies Used:
Community dialogues and action days.
School health outreach.
Market day health booths.
Door-to-door sensitization.
Planning Requirements:
Clear objectives.
Trained teams.
IEC materials.
Success Tips:
Mobilize local leaders.
Use peer educators.
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18. Support Supervision
Types:
Routine (monthly).
Spot checks.
Joint supportive supervision with county officers.
Focus Areas:
Data quality.
Service delivery.
CHV/CHC motivation.
Best Practices:
Use friendly tone.
Give feedback immediately.
Supervision Tools:
MOH 516.
Peer-to-peer observation forms.
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19. Appraisal of CHVs and CHCs
Why Appraisal Matters:
Motivates good performers.
Identifies training needs.
Helps with retention.
Appraisal Process:
Use standard criteria.
Conduct at least annually.
Include self-assessment.
Recognition Ideas:
Community certificates.
Health day celebrations.
Inclusion in planning meetings.
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20. Identification of Areas of Improvement and Corrective Action
Sources of Gaps:
Supervision reports.
Missed targets.
Feedback from the community.
Steps in Corrective Action:
1. Identify the problem.
2. Analyze root causes.
3. Develop SMART action plan.
4. Monitor implementation.
Common Actions:
Retraining.
Closer supervision.
Role adjustments.
