PUBLIC HEALTH CARE AND

COMMUNITY STRATEGY.
By MUOKI.
Historical background of PHC.
 In 1997 the world health assembly with Kenya alongside other
member states of WHO endorsed the worldwide social
objective of attainment of health for all ppl by the yr 2000 over
a lever of health that will permit the to lead a society of
economically productive life.
 PHC was endorsed by the countries that attended a world
conference that was in Alma-Ata and they came up with a goal
a of health for all by the yr 2000 and beyond.
 However many countries in the developing countries could not
attain this due to lack of resources, so they needed to adopt a
strategy that allowed them to use the available resources to
reach everybody.
Cont.…………
 No developing country has enough money to run all the health
services, hospitals are expensive to construct and mostly dealt with
more curative services for the sick and little on preventive services.
 The strategy of primary health care was adopted by the Kenyan
government to provide H.C to its population majority 80% being in
rural areas.
 The PHC forms an integral part both of the countries health system
of which it is the central function and the main focus of the overall
social and economic development of the community.
 PHC is the fist level of the contact of individual family and
community with the national health system, bringing H.C as close
as possible to where ppl live and work.
Definition of PHC.
 Is essential health care based on particular scientifically sound
and socially acceptable methods and technology made
anniversary accessible to individual and family in the
community trough there full participation at the cost
affordable by the community and country to maintain at every
stage of development in the spirit of self reliance and self
determination.
Emphasis of PHC.
1. It is the first contact of health care or primary
medical care.
2. Heath services for all so as it is intended to
reach each individual esp those in need.
3. It involves individual family and community.
X-tics of PHC.
1. Universally accessible to the individual and family in the
community.
 If refers to the continuity of care which shd be within reach to

every individual in the community.

2. Socially acceptable to all.
 The health care is appropriate and adequate in quantity to

satisfy the health needs of all ppl and the methods are
acceptable to the m within there cultures and norms.
3. affordable.
 Services are provided at a cost that the community can afford.
Cont.……….
4. Promote full participation.
 Made available to them thro’ there full participation meaning that

the community shd assume responsibility in promoting there health.

5. Appropriate technology.
 Use of the methods and techniques that are locally available and ppl

can solve there own problems.

6. Socially accepted methods which the country can afford.
 Self reliance and self determination.

 NB: PHC strategy ENCOURAGES self care and self Mnx in the

health and social life. Ppl shd be educated and empowered to use
there own knowledge, attitude and skill in activities that improve
health for themselves their families and the community.
Components of PHC
 Ideas about the implementation of health care for all and it is usually
identified using 5As.
 A- accessibility. Meaning that the services are geographically,
financially, culturally within easy reach to the whole community.
 A- acceptability. The quality of health services offered are appropriate,
adequate and able to satisfy the health needs of ppl and are provided by
methods which are within the social cultures and norms.
 A-affordability. The services are provided at a cost that the community
can afford.
 A- availability. The health services are easily available to the community
and help them assume responsibility in promoting their health.
 A- appropriate technology. The methods, technology and resources are
within the community.
Principles of primary health care.

1.Equitable distribution.
 The manpower and health services are equitably distributed

and at a cost that is effective.

2. Manpower development.
 Capacity building of the health care workers to be done like

seminars and own job training.

3. Community perception.
 Full community involvement to identify their priority health

problems, plan organize, implement and evaluate with them.

 Involves the community in decision making to own the

project.
Cont.….
4. Appropriate technology.
 Methods used shd be socially acceptable locally available and

scientifically sound.
5. Multi sectorial approach.
 Involves other sectors since health cannot be alone. E.eg

agriculture, education, finance, infrastructure, NGOs and self

help groups.
 Commitment of all sectors increase the purpose of joined

efforts to contribute towards health of community and avoid

conflict and duplication of work.
Pillars of PHC.
1. Heath system.
 It’s the first element of a community health care process where by

in it we shall give the heath education.

2. priority.
 It addresses many health care problems in the community

providing promote, preventive, curative and rehabilitative services.

3.science.
 Its based on application of the relevant results of social biomedical

and health services research.

4. culture.
 Reflects and involves from the economic conditions and social

cultural and political xtics of a country and community.

Cont.……..
5. Equity.
 Equitable distribution and attainment of health for all ppl by

the yr 2000 and beyond.

6. participatory.
 The full community participation so that the ppl have right

and duty to participate in planning and implementation of

health care services.
7. sustainability.
 At the cost that the ppl can afford to maintain.

 Ppl to exercise political will and mobilize for resources.

PRINCIPLES OF PHC.
 Equitable distribution- manpower and H. services shd be equally
distributed and cost effective.
 Manpower development- capacity building of H.W to be done
though sometimes and on job training. There shd be
development in the community where community is taught
about things such as good nutrition.
 Community participation- fully community involvement to
identify there problem, plan, organize implement and evaluate
with them involve community in decision making for them to
own there project.
 Appropriate technology- methods used shd be socially accepted
and locally available and scientifically sound.
CONT……
 Multi sectorial approach- involves other sectors like
agriculture, finance, water, self help group, NGOs, hosing
donors.
 The commitment of all sectors making sure that each sectors,
makes sure that sectors has a plan to avoid conflicts or roles
and function or duplication of work.
 Eight elements of PHC were identified in the ALMA-ATA
conference but individual contained countries were given
liberty to hand other duties.. Kenya added five more.
CONT………
 E- ducation concerning the H. problem.
 L-ocal dzz control.
 E-xpanded programs on immunization.
 M-ertanal H. care and fp.
 E- ssential drug supply.
 N- utrition and food supply.
 T-reatment and prevention of common dzz and injury.
 S- safe water treatment supply and sanitation.
 Maternal health.
 Dental health community based rehabilitation.
 Malaria control.
 STI, HIV/AIDS and TB control.
a. HEALTH EDUCATION.
 H. education is intended to have a positive impact in health.
 It is a process of dialogue with community members to find out
appropriate response to health problems.
 You empower them with knowledge and insight them to understand and
change there behavior.
 It deals with dzz control and prevention thus promoting health.
 It gives individuals and community with capability of maintaining good
health.
 It is an integral part of all health services.
 It can be given in schools, hospitals, barazas, churches, harambees, in
women and men meetings.
 The gov’t has trained H.W, social workers, councilors to give health care.
b. LOCAL DZZ CONTROL.
 This is controlling the communicable dzz and vector borne
dzz. This are prevented with preventable measures.
 Control of dzz is essential and it is the fast step in H.care
system.
 Community shd put more emphasis on control of the dzz its
easier.
c. EXPANDED PROGRAM ON
IMMUNIZATION.
 H. care of children and mothers from greater part of the
community health.
 They are also greater risk due to lowered immunity.
 The MCH/FP services are aimed at promoting health of mother
and child reducing the maternal and child motility and morbidity.
 The gov’t provides the vaccines and Workers. All the under 5s
shd be immunized against the imunizable dzz.
 Immunization is very effective in prevention agaist childhood
dzz.
 HW have been trained on how to motivate the mothers for
immunization, how to suspect cases of immunizable dzz.
CONT…
 The country has incorporated all new upcoming vaccines and
the HW have been trained on the same.
 FP enables women of reproductive age to have the number of
children they can desire and reduce chance of unwanted pg.
 In MCH/FP the services offered are the prenatal services
antenatal and postnatal services.
d. ESSENTIAL DRUG CONTROL.
 Basic drugs are used to meet minor illnesses at health centers
and other hospitals.
 They are supplied by KEMSA. It is the responsibility of the
nurse in charge to make sure that drugs are made available to
the pts and the community.
 It is the responsibility of the individual and community to
ensure drug compliance. Pts to take drugs as prescribed.
e. PROPER NUTRITION AND FOOD
SUPPLY.
 Malnutrition is common in infants, children and lactating mothers.
 It can be due to poverty, economic or cultural factors in the
community.
 HW is responsible in:
 Prevention and rx od diarrheal dzz to prevent malnutrition.
 H. education on ppl on proper diet.
 Involve agricultural development to encourage ppl to plant food
suitable to climatic condition, prevent post harvest spoilage, to
keep portly, daily cattle, and have kitchen garden.
 Rx and prevention of communicable conditions, dzz and injury,
curative care is important.
CONT….
 The common conditions include:
 Diarrhea.

 Skin dzz.

 Worm infestation.

 Common accidents.

 Eye conditions.

 Acute respiratory tract infections.

 The community shd get curative services and get H. education

on the same.
f. SAFE WATER SUPPLY AND PROPER
SANITATION.
 These are available to the Kenyan population.
 Many water borne dzz can be prevented by having clean
water and proper refuse disposal.
 CHW together with HW shd educate community on
construction of latrines, safe water and how to make it safe.
g. MENTAL HEALTH.
 H is a state of complete physical, psychological, spiritual and
social well being and not merely absence of dzz or deformity.
 Mental H. services shd be viewed as integral part of other health
services that are needed to achive the complete H of individual,
family and community.
 HC shd be able to look at mental health as a part of the PHC
element.
 Promote good mental H services thro’ H education to family and
community to create awareness, provide H services to all H
institutions to detect rx and refferal systems to mental dzz, seek
H as soon as abnormal bahaviour is observed and educate
community to avoid substance abuse.
h. DENTAL HEALTH.
 Dental dzz are wide spread in the community and can be
prevented.
 Most dental dzz are due to poor lifestyle like eating sugary
foods.
 Educate the community to have regular dental check up.
 Most ppl see dentist when the teeth are aching. HW shd
provide regular H services thro’ outreach and mobile clinics.
 Use of local tooth picks shd be encouraged .
 Avoid harmful traditional habits like tooth extraction.
 Eat indigenous foods and avoid sugars.
 Gov’t to train dentists to provide Services.
i. COMMUNITY BASED
REHABILITATION.
 It is required to give special attention to Mnx and prevention
of disabilities that might be raising from congenital
malformations, accidents and from some imunizable dzz.
 Dzz can come from some incommunicable dzz like DM,
HTN.
 These ppl shd be supported coz disability is not inability.
 Gov’t shd provide schools and centers to train these ppl to be
self reliant.
 They can do jobs that suit there disability.
 Encourage the community to accept them.
k. STI, HIV/AIDS AND TB.
 Aim is to control and prevent the infection, treat conditions when
they occur, reduce new infections and reduce stigma associated
with HIV/AIDS.
 Gov’t shd train more HW on the same. Work with private sector
e.g. NGOs.
 HW to give H. education to the community.
 There shd be drug adherence and stigma reduction.
 Organized H activity day e.g. HIV and TB days.
 H. education to the community on behavior change, use of
condoms, accepting family members affected, home based care, rx
of STIs, empowering women who are venerable to HIV by
improving there H. education, regal status and economic status.
HEALTH SERVICES IN KENYA BEFORE
IMPLEMENTATION OF PHC.
 SINCE KENYA GOT independence in 1963 the gov’t has shown
commitment towards H provision that is quality via manifesto.
 Major milestones achieves are as follows:
• 1965 gov’t free medical treatment thro KANU.
• 1967 national FP program started.
• 1970 central gov’t took over running of health services from local
council.
• 1971-72 gov’t of Kenya and WHO formulated formation of a rural
training centers ( rural demonstration center for training like
kalulumo, chulaimbo, mbale, maragwa, mosoriot and tiwi.
• 1981 community based H. care was set within the integrated rural
H and FP program.
POLICIES THAT AIDED
IMPLEMENTATION OF PHC.
 Development of the PHC has made it necessary to continuous review of
the H system.
 The following are the policies that aided in the implementation of PHC.
o District focus for rural dev’t- introduced by the gov’t in 1985. the aim
was to decentralize decision making in the rural Ares then the district to
be the center for organizing, coordinating, planning, implementation
and evaluation the H. programs.
o Increased coverage and accessibility of H. services in rural area. It was
realized that rural H. infrastructure was behind so the gov’t made effort
to direct finance to rural areas for the dev’t of H services.
o Consolidating urban rural promote and curative services.
Complimentary approach in the allocation of resources and proper mnx
of various H components.
CONT……….
HW are trained on preventive and primitive methods and
encouraged to include H education of a routine component of their
activity.
o Intersectoral collaboration- H is too important to be responsibility

of the health sector alone.

o Increase emphasis on maternal child health and FP. This is done

to reduce maternal child motility. MCH/ FP have made impact.

o Increasing alternative financing the chanism since H care as

become expensive there is clear shift from free medical services

to cost sharing. The communities are encouraged to build H
facilities in the community. Payment of taxes and insurance
policies.
LEVELS OF PHC IMPLEMENTATION.
1. Family level.
2. Community.
3. Locational.
4. Divisional.
5. District level.
6. Provincial.
7. National level.
a. At family level.
 Family does not only provide its members with food, clothing and shelter
but also provides basic education in language and believes, education on
health and prevention of dzz.
1. It is effective in the home environment and demonstration can be done in
the home setting with active participation of family members.
2. Nutrition and food supply. Good nutrition is important for healthy growth
and development. Teach each family member about good nutritional
practices, good storage and growing of food.
3. Water and sanitation.
 Motivate family to treat water to make it safe by using cheap methods like

boiling and 3 pot systems. Teach them on the protection of water resources.
 Use of latrines, personal hygiene, proper waste disposal and harvesting of

rain water.
CONT………
4. Maternal child health.
 Encourage good traditional practices like prolonged BF. The

family shd know importance of ANC, FP, postnatal

importance and discourage bad habits.
5. expanded program on immunization on the family.
 Teach importance of immunization. It is the responsibility of

the family to take children for immunization.

 Control of endemic dzz like malaria.

 The role of the family is to ensure safety. They shd know

measures to take when one is sick, use of ITN, drainage of

stagnant water, crealing bushes and covering of water.
TREATMENT OF COMMON DZZ AND
CONDITIONS.
 Dzz like diarrhea, malnutrition vomiting etc.
 The role of the family is to recognize the signs and symptoms
and seek help.
 Ensuring that the prescribed rx is given correctly.
 Understand the consequences of these dzz and take the
measures to prevent them.
mental health in the family.
 Family shd recognize that mental H are just like any other dzz
 Seek help if abnormal behavior is seen in any members.
 Adopt of practices that promote good mental behavior, avoid
alcoholism and support the affected.
Dental health care at the family level.
 Family shd ensure good dental health like regular cleaning, using
indigenous food, reinforce good practices, regular dental check
ups.
community based rehabilitation.
 Family member to be educated on reduction of disability and give
help to those affected.
 Immunize children to avoid dzz like polio which bring out
disability.
HIV/AIDS and TB prevention in the family level.
 Teaching openly to children about HIV prevention. Nursing
members of the family with HIV and help them to socialize with
others.
b. IMPLEMENTATION AT THE
COMMUNITY LEVEL.
 Community seek education on how they can improve there
health from HCWS.
 Community members can educate each other and motivate one
another.
nutrition and food supply.
 Identify high risk individuals and provide relevant care.
 Promoting better food production, storage and marketing.
 CHW teach the community on food and nutrition.
water and sanitation in the community.
 Community to work closely with public health technicians in
the construction of pit latrines.
Maternal child health and FP.
 HW train community and supervise traditional birth attendants and
community HW ensures availability of contraceptives.
immunization of community.
 Ensure community utilizes services. HW ensures supply of vaccines and
cold chain.
 Immunization shd be provided daily for the community.
control of endemic dzz.
 Role of the dispensary is to support dzz control activity, ensure constant
supply of drugs and other supplies, keep records and pass information to
the next level of reporting.
rx of common conditions.
 Common health workers shd be trained to diagnose, treat, maintain
records like prepare ors and referral.
ESSENTIAL DRUG SUPPLY IN THE
COMMUNITY.
 H. centers are responsible for the technical supplies of
essential drugs and there use.
dental health.
 HW to provide information to the community about dental
health and to refer.
community rehabilitation.
 Mobilize the community to adopt measures that promote good
physical H and accept ppl’s disability.
 Train HW to prevent disability.
 Rehabilitation control centers shd be at the community level.
CONT…………
HIV/AIDS in community level.
 HCW shd facilitate in promoting services, curry out research
services like immunization, condom distribution promoting of
early dx via VGT.
DISTRICT LEVEL.
 H services in the district. Its services well defined population.
It includes all H care emergencies in the areas e.g. gov’t and
private, professional and traditional.
 The district H Mnx team (DHMT) coordinates activities of
PHC in district, contributes in promotion of preventive,
curative and rehabilitative H services.
 DHMT is a team constituting of DMOH- head of the HMT,
DPHN- district public health officer, health Mnx information
system office (concentrates on records), district dzz
surveillance officer (concerned on the dzz out break) district
health education officer, district nutritionist.
EDUCATION.
 DHMT is in charge of workers to coordinate various H
education programmes, produce and distribute various
education programmes, distribute simple learning materials at
the district level like charts.
nutrition and food supply.
 DHMT ensures food security for the district. Establish early
warning system and analyze district nutrition surveillance
data.
maternal child health and FP.
 Role of the DHMT is mainly to train HW and monitor
MCH/FP activities in the district.
CONT………..
Immunization.
 DHMT is responsible for the distribution and supply of
vaccines. Evaluation of the district immunization coverage,
assist in the maintenance of cold chain equipment's, supply of
vaccines and logistics.
control of endemic dzz like malaria.
 District level keep records and recognize outbreaks of
endemic dzz thro’ surveillance, takes appropriate action,
provide adequate drugs, manage referrals from H center and
dispensaries.
RX OF COMMON DZZ.
 DHMT is responsible for monitoring and training HW in the field,
produce and update operational manuals to be used in the community.
 Distribute supplies and Mnx of referrals.
essential drugs supply in the district.
 DHMT ensures delivery of drugs kit to all H facilities. Responsible
for continuous education and monitoring of the drugs.
mental health.
 Ensures mental H is implemented in the district. Provide training of
health workers on mental health.
 Provide transport for mobile community based mental H activities
and mobile clinics. Maintain register of mental H activities of
inpatient and out patient. Educate mental H in the district.
DENTAL HEALTH.
 Gov’t policy is to have dental units and qualified dentists.
District level act as a major referral centers. Can also refer
dental cases to provincial levels where there are better
equipment like dental x-ray and labs.
district based rehabilitation.
 It is the responsibility of the district to integrate community
based rehab with other H centers.
HIV/AIDS and STI in the district.
 It ensures services are available and drugs they get referral
sand reports fro health centers and dispensaries, hold seminars
and work shops to educate HWs.
PROVINCIAL LEVEL.
 It is the highest level in PHC. Implementations, policies are
transported into strategies for implementation and therefore referral
hospitals are found.
 Provision of training and continuing education programmed for all
health personnel.
 Dev’t of mass media for different ppl and language of the ppl and
preparation of health materials.
 Formulates policy guidelines on things like food, nutrition,
immunization, FP and control of dzz.
 Collaboration with other ministries, self help groups and NGOs.
 Monitoring and evaluation of activities from district level.
 Dzz surveillance and monitoring of drugs.
CONT……..
 Participation in the preparation of national immunization
activities.
 Personnel and logistics support e.g. finance, transport,
materials and man power.
 Ensure steady supply of drugs,contracetives, essential drugs
and other supplies.
 Coordinates donor assistance.
 Making, provision of renovation and modification of hospitals.
 Implementing strategies for promotion of mental and dental H.
 Ensuring implementation of HIV/AIDs policies and creating
awareness.
RESPONSIBILITIES OF KEY
IMPLEMENTATIONS OF PHC
 5 Key implementations.
 CHW
 Community.
 Government- ministry of health.
 Other government ministries.
 NGOs.
CHW
 Are individuals selected by there community for training on how to
deal with village H problems and treat common dzz.
 Once trained they work part time as volunteers.
 How they are selected: it is done by the community after the
members have been sensitized on the role and advantages of CHW.
CONT……….
 Several conditions are selected and interviewed by the community H committee
and trainers.
 CHW shd have the following qualities:
 Be a prominent resident of the area.
 Be mature and responsible individual.
 Be accepted and respected by the whole community.
 Be self supporting and ready to work as volunteer.
 Be able to relate well with the others and a good communicator.
 Physically fit.
 Be a gender acceptable to the local culture for the kind of activity to be
undertaken.
 Be intelligent with education that suits communication.
 Be ready to learn.
 Be of age suitable for training and for continuing work in the community.
Roles of CHW.
 Shd be able to motivate others
 Shd be a good role model and of behavior.
 Shd be a link btn community and H system and other sectors.
 Shd be a technician with other skills of community importance like
latrine construction and rx of common illness.
 Shd be a observer, recorder who is capable of thinking, reacting and
accessing progress.
 Organizer and mobilizer for community activities.
 Shd be a leader, manager, advice and councilor.
 CHW are supervised by the community thro the leader of the village
health committee.
 Community participation in the supervision of CHW is one of the key
determinant of the success of the PHC activities.
WAYS IN WHICH SUPERVISION IS
CARRIED OUT.
 Motivation- showing appreciation by giving rewards and
providing more education to CHW.
 Supportive- necessary equipment and supplies.
 Recognition- done by establishing credibility of CHW in the eyes
of the community or congrat when the community is around.
 Planning- help them to plan their objectives and logistics.
 Problem solving- assisting CHW in solving problems they ace in
the community.
 Training- on going education and skill development to CHW.
 Performance measure- measuring there performance against there
set objectives.
AREA THAT A CHW COVERS.
 The area covered is determined by the following factors.
 The primary health care workers.

 The population of the community.

 The gov’t and NGOs in that community.

responsibility of community is key implementer of PHC.

 Community the center of focus in PHC.

 Responsibilities include:

 Recognize priority problem related to health.

 To decide what to be done to overcome.

 To decide what community can do to solve the problem.

 To organize and implement what themselves can do on there own or

with support of the NGOs or the gov’t.

CONT………..
 They monitor and evaluate the activity.
 Community can achieve these responsibilities using the following

activities.
 Community participation.

 Community awareness.

 Community involvement.
 Community participation is the process in which the community

mobilizes resources, initiate and take responsibility for its own

developmental activity and share in decision making and
implement in developmental program.
 Community awareness- community is made aware of these

problems and the resources available e.g. manpower, time idea..

CONT………
 Community awareness can also be achieved thro’ involvement,
participation in community diagnosis.
 They can succeed by making community meet other different
programs and borrow from them. Bench marking’’
 Community involvement- it is active and willing participation of
the community in planning, evaluation, implementation, Mnx and
evaluation of programs which contribute to the well being of
community.
 It also contributes to attaining community responsibility and
accountability.
 Participation and involvement leads to self reliance and helps the
community in development.
FACTORS THAT INFLUENCE
COMMUNITY INVOLVEMENT.
1. Favorable political will- where the favorable will ppl will
have peace.
2. Education status of the community- literacy may speed much
route in dev’t.
3. Community infrastructure- e.g. communication network like
roads.
4. Economic factors- when ppl have money they contribute.
5. Level of intersectoral coordination at the community level-
if sectors work together things are worked well.
RESPONSIBILITY OF THE GOV’T AS
THE KEY IMPLEMENTOR.
 Political and economic stability as contributed to dev’t of PHC in
Kenya.
 The gov’t has continuously reviewed and revised strategy in our
HC system. Existing policies have been reviewed and new others
added.
responsibility of the gov’t in national level.
 To provide overall coordination of PCH in the country.
 Review and evaluate PHC activity with a view of identifying areas
that need strengthening.
 Provide technical and financial support for PHC activity.
 Promote intre-sectoral collaboration with relevant institutions and
NGOs.
CONT……
 Rease with WHO, UNICEF and other organizations on matters concerning
PHC.
 Maintenance of a data base on PHC development and provide quarterly and
annual report on progress.
at provincial level.
 Provide technical support in the planning and mnx of PHC at the provincial
level.
 Provincial health mnx team is responsible for all activities of PHC in the
province.
district level gov’t responsibility.
 It is at district level that PHC activity take place.
 Identify existing problems and decides on what actions to take.
 Identify resources available to improve health.
 Provide technical support to PH activities in the community.
CONT……
 Identify resources available from community gov’t and NGOs.
 Monitoring the implementation of district plans both by
activities copied out by each of thr sectors.
 There is formation of district development committee and its
work is t plan and coordinate all developments work inn the
district including PHC.
WHAT GOV’T IS DOING AT THE
COMMUNITY LEVEL.
 It is the policy of decentralization and support for community based.
 It care approach, the gov’t has assisted community to set up village H

committee. This committee is selected by the community in village and

consist of 6-12 members.
 It assists in:

 Assisting in identifying H problems in the community.

 Identify community resources.

 Coordinating in planning activities aimed at overcoming specific H problems.

 Helps community in selecting CHW and provide administrative supervision

for the work.

 Provides channels of communication btn community and H development

committee.
 Initiates and participates in communal income generating activities.
CONT……
 Works hand in hand with the ministry of H to achieve PHC
like agriculture, water, housing and education.
NGOs
 Works and in hand with the ministry of H to implement PHC.
 NGOs Have been actively involved in developing community
based HC e.g. world vision, AMREF, hagacan H services,
action aid, red cross, saint john ambulance, catholic relief
servicers in Kenya.
ACHIEVEMENTS OF PHC.
 The country has won wide spread acceptance among gov’t
ministries, NGOs and community in provision of care.
 Childhood immunizable dzz have recused due to KEPI.
 Improvement in equitable distribution of resource.
 Has lead to encouragement in achievements in global target dzz
eradication and control.
 There as been extensive expansions and coverage of several PHC
elements like nutrition, environmental health etc.
 It contributed to reduced gap btn rich and poor by offering free
medical services.
 Focuses on community by introducing community health workers.
CONT….
 Involvement of community in planning and learning there own
health services via community participation.
 Training of HW on preventive and promotive HC and continuous
professional dev’t.
challenges of PHC.
 High motility and morbidity of under 5s due to immunizable dzz
which could be prevented thro immunization.
 High cost of drugs and equipment's used in health care system and
they cover 70% of health's budget.
 Climatic conditions leading to poverty hence malnutrition.
 Dzz burden-emerging of new dzz like HIV/AIDS and related dzz
like TB and pneumonia.
CONT….
 National and human disasters leading to loss of property and
life.
 Most ppl in Kenya lack safe water and sanitation leading to
communicable dzz.
 Political instability leading to IDPs leading to transmission of
dzz.
 Malaria and respiratory dzz are an increase.
 Primary H care programs like KEPI depend on donors raising
concern on sustainability.
ADOPTING OF PHC IN YR 2000 AND
BEYOND.
 Due to the above challenges the country has raised concern among stake
holders and H sector. Ministry of H has held several constructive meetings and
work shops to try and reverse the deteriorating H situation in the country.
 A major outcome as come with information of national health sector strategic
plan. NHSSP.
 The plan was developed to address constrains in the health sector and adopt a
sector wide approach in their resolution.
 The ministry of health and developing partners developed NHSSP to set the
health sector reform.
 The NHSSP concern was on structural, financial, and organization.
 The ministry committed itself to decentralize by providing increased authority
for decision making, recourse allocation and Mnx of H care to district and H
center.
 This was to allow greater participation to community Mnx of funds.
ROLES AND RESPONSIBILITIES GIVEN TO EACH
LEVEL TO IMPLEMENT THERE REFORMS.
 At the MOH headquarters. The role of headquarter is
restricted to policy formulation and development, strategic
planning, setting standards, regulating mechanisms and
coordinating H training.
 Coordinating donor activities.
 Overseeing implementation of reform processes.
 Ensuring equitable allocation of the national H resources.
at provincial level.
 Supervise H at district level.
 Mention H standards for services and infrastructure.
 Assist district in developing there plan.
DISTRICT LEVEL.
 Prepare work plan and implementation of district plan.
 Provision of curative, preventive, rehabilitation and primitive PHC

activities.
 Coordinating and supervising other H sectors.

 Coordinating other sectors, donors, NGOs on H related issues.

WAYS FORWARD FOR PHC.

 Gov’t is committed to improve the country H status. So there was

introduction of policies and refers and strategies in order to implement

PHC.
 every individual can do the following to improve the implementation of

PHC:
 Rational use of resources like funds allocated to them. We are in current

with new dzz, rx regimen, gov’t policies as they keep changing.

CONT……….
 Advocating for policy change and good governance at levels.
 Effective dzz surveillance and reporting so that measures can
be taken in good time.
 Implementing PHC at your level.
COMMUNITY STRATEGY.
BY JENNIFER MUOKI.
COMMUNITY STRATEGY.
 It is an approach that was formed to enhance community
access to H care in order to improve individual productivity
and thus reducing poverty, hunger and child & maternal
deaths as well as to improve education performance.
historical background on community strategy.
 It was noted that PHC was not very effective esp at the
community level.
 Therefor community strategy was started to bridge the gap btn
community and the health facility.
 It was launched in 22nd June 2007.
HOSPITAL LEVELS.
 Levels by KEPHS- Kenya essential package of health services.
 Tertiary hospitals national level.

 Secondary hospitals provincial.

 Primary hospitals.

 H centers, maternity and nursing home.

 Dispensaries and clinics.

(interphase)
 Community.
IMPLEMENTATION FLAME WORK AND
THE PROCESS.
 Community are at the foundation, equitable and effective H care. The
Community represent level one in KEPHS which was proposed in
second national health sector strategic plan 2005.
 For the success of NHSSP 2, a Specific strategy was developed and
rolled out “taking KEPHS to the community” thus it was referred to
as community strategy.
 The goal for the community strategy was to be accomplished by
established sustainable level 1 of service aimed at promoting dignified
livelihood across all stages of the life cycle .
 The community based approach was set out in community strategy. It
is the mechanism though which household and community strengthen
there role in health and H related issues by increasing their knowledge,
skills and participation.
CONT………
 The community shd asses, analyses, plan, implement and
manage there own health issues.
 It is important to integrate level one H activities by all the
stake holders into the H care system.
 community strategy was started to take H services to the
community at the grassroots and to reverse the trend from up
down to down upward process.
 It was started in some districts as a pilot then it was being
rolled out to other districts and counties.
GOVERNING STRUCTURES IN THE
COMMUNITY STRATEGY.
 House hoods.
 Village.
 Community H comities.
 H facility Mnx committee.
house hood.
 It consists of children, parents and care givers.
 The head of the housed hood is the one involved in decision making in
that family.
 Household forms the first level of health care- they have important
responsibility for addressing members health needs at all stages of there
life cycle.
 Among responsibilities are H promotion, dzz prevention governance and
mnx of H services and claiming there right to quality H services.
CONT……
FUNCTIONS.
 ensuring shelter.
 H diet.
 Environmental H, personal hygiene, prevent dzz and
accidents, abuse, ensure gender equality, monitoring H for its
household members, provide appropriate home care for the
sick, ensuring children finish immunization schedule and
ensure drug compliance.
VILLAGE.
 Is made up of many house holds according to the population
and they make a community unit and is ahead by a headmen.
Fxn of headmen: Ensure food security, safe water, good clean
environmental practices, safety of there members, community
work like building schools and infrastructure in there areas.
Community unit.
 Comprises of approximerly one thousand house hoods or 5000 ppl living in
some geographical area sharing resources and challenges.
 In most rural areas such as units wld be the sub locations.

 No of house hoods determines the number of CHW to be selected.

 One community worker serves 20 -30 households.

linkages with FBO, CBO and other developments.

Ministry has realized that in order to deliver they have to work with other groups
that work towards H.
They are involved in committees and consultative meetings from grass root,
community to higher level.
Their roles and fxn are well stipulated to avoid duplication of work and conflict.
The government of Kenya FBOs, NGOs provide monthly forum for donors to
discuss economic dev’t issues to increases effectiveness and efficiency and
external assistance in Kenya.
CONT………
community H committee.
 It is the H governance structure closest to the community.
 The members are elected to present all villages in the
community unit.
 This committee shd be elected in assistant chief’s barazas.
 In this committee the CHW shd be the treasurer and the
community H extension worker is the secretary.
 There shd be other 9 additional committee members including
representation frm the: youth, women group, NGOs, faith
group, ppl with HIV/AIDs and ppl with disability.
 At least one third of the committee team shd be women.
ROLES AND FXN OF THE COMMUNITY
H COMMITTEE.
 They identify community H problem priority thro meeting.
 Do planning community H action days like creating awareness on certain
issues.
 Participate in community H action days.
 Monitoring and reporting on planned H action days.
 Mobilizing resource for H action days.
 Coordinating community H workers activity.
 Reporting to level two and 3 on priority dzz and other H conditions.
 Leading community H when there is outbreaks of dzz or campaigns and
outreach in it.
 Advocating for good health in the community.
 The community H committee shd meet shd meet monthly mainly to
receive reports.
HEALTH FACILITY MNX COMMITTEE.
 It is found in level 3. It shd have 14 members.
 The facility in charge and PHO are ex officials of the committee are there
due to there position.
fnxs and roles.
 To supervise activities at level 2.
 Organize quarterly performance, review meeting to all facilities in the
catchment area.
 Preparing quarterly reports and submitting them to the DHMT.
 Overseeing the fnx of the H centers in support of level one service provider.
 Provides technical and professional guidance via supportive supervision.
 Managing r/ship with divisional level stakeholders.
 Mobilizes resources for dev’t of H facilities as well as supporting out reach
and referral activities.
ACTIVITIES AND IMPACT FOR
IMPLEMENTATION OF COMMUNITY STRATEGY.
 There are two categories of personnel promoting H at the community level.
 Community HW.
 Community extension worker.
roles of the CHW.
 teach the community on how to improve H and prevent illness.
 Treat common illness and minor injury like giving first aid with guidance
and assistance from the CHEW.
 referring cases to the nearest facility.
 Promoting care seeking behavior and compliance to the rx given.
 Promoting home based care for the sick and doing referral.
 Visiting homes to determine the health situation.
 Participate in the monthly community unit H action days.
 Motivate members to adopt H promoting practices.
COMMUNITY H EXTENSION WORKER.
 Is a trained H personnel with a certificate in nursing or PHO.
 They are usually employed by the gov’t.
roles.
 Overseer in selection of CHW.
 Organize and facilitate in CHW training.
 Monitor and manage CHW’s drugs kit.
 Supporting and supervising CHW.
 Compiling report CHW and forwarding to level 2 or 3.
 Receiving feedback from level 2 and 3 facilities and passing it
to the CHW thro’ a dialogue and planning.
DHMT selection of CHEW.
 CRITERIA- must have qualified for PHO or nursing.
 Must be mature and responsible.
 Be acceptable to the whole community.
 Be a good communicator.
 Be able to be available for the services of the customer
according to the demand.
 Shd be willing to teach and mentor the CHW others.
 Be able to work with ppl for different backgrounds.
Roles of other H care team.
At level 2 we have the Mnx committee.
 It shd have 12 members with equal representation of the community unit.
 They establish linkage btn the H system and community.
 Planning, implementing, monitoring and evaluation of H action at the
facility and community unit served.
 Provide feedback to level 1 services.
 Facilitate regular dialogues btn community and H service providers.
 Mobilize resources for dev’t of H facilities, supporting outreach services
and referral services.
 Participate in community H days.
 Strengthen community involvement in decision making.
 Listening to and addressing complains expressed by clients thro
suggestion box.
Community participation and
involvement.
 It is letting community recognize their own health problem, set priority
and work with them towards owning their project.
 It is a process by which the community are actively involved in al stages
of project and program implication.
importance of community participation.
 Help the community members to identify and prioritize their felt H needs.
 Enhance sense of ownership.
 Promote sustainability of the project.
 Help ppl to change there attitude.
 Reduce project cost.
 Promote dev’t.
 Enhance and promote utilization of resources.
Factors that hinder community
participation.
 Inadequate awareness.
 Poor leadership.
 Dependency syndrome- ppl expect t be given money if they participate.
 Political influence interference.
 False promises from implementing agencies.
 Lack of prioritization of community needs.
 Gender bias.
 Application of inappropriate technology.
 Poor timing of activities.
 Lack of transparency.
 Use of unskilled change agent.
 Lack of decentralization in decision making.
Promoting community participation.
 Conducting dialogue based on evidence.
 Conducting regular feed back meetings at all stages of
implementation.
 Build on strength not on needs.
 Strengthening existing structures rather than starting new ones.
 Create awareness on all levels of implementation process.
 Involve community at all stages of planning and action.
 Enhance joint investments in activities benefiting all parties
involved.
 Involve everybody: men, children and women.
 Build the capacity of the community
 Apply appropriate and effective technology.
Roles of DHMT.
 to train CHEW.
 training of level 2 and 3 service providers.
 Supportive supervision.
 District planning and report writing and giving feedback to the
community.
 Monitoring and evaluation of the programs.
 Mnx of community duties, logistics and supplies, operational
research.
Divisional H stakeholders forum.
 Membership shd include DO as the chair.
 PHO is the secretary.
members.
 Community based organization.(CBO)
 FOB
 NGO
other sectors.
 Agriculture.
 Environmental.
 Education.
 Water.
 Social services.
 Roads.
Functions.
 Information sharing of areas of coverage among the partners.
 Identify gaps in the divisional H interventions.
 Mobilize any additional resources to address the gap.
 Keeping of records and reports from the community.
 Look on infrastructure and commodity Mnx.
 Operational research.
district dev’t committee.
 Has 10 members. And the DO as the chair and is at the district level.
fnx.
 Ensure dev’t in the H institutions in the district.
 Ensure equitable distribution of resources.
 Mobilize resources for dev’t.
 Work together with the other ministry e.g of planning and housing.
 Support dep't activities in levels 4,3 and 2.
District H stake holders forum.
 It draws membership from all organizations involved in the
provision of curative, preventive, rehabilitative and promotive
H care services within the district.
 They include: NGOs, FBO, CBO and private sector hospitals,
nursing homes, clinics, pharmacies, gov’t hospitals and gov’t
line ministries.
 Include dev’t policies, civil society, media women
organizations, H partners like district commissioners, Dos, DC
and chief etc.
 Chair of this DC secretary is DMOH.
Roles.
 Review divisional H stakeholders reform reports.
 Discuss the H priorities in the district with DHMT and agree
on how to program the H. activity.
 Provide input to the district H planning process.
 Participate in resource mobilization.
 Participate in joint planning and budgeting to develop
integrated district H. plans.
 Review comprehensive district H plans and other reports.
District H Mnx bond.
 Chair is the DC secretary is DMOH.
 Provide leadership and accountability in support ot level one
activities.
 Coordinates district H services in collaboration with the stake
holders.
 Approves plans and budgets.
 Receives implementation report progress.
 Mobilizes resources and allocates to various levels.
 Submit report from facilities to provincial and national level.
Technical stake holders forum.
 Members include: NGO, FBO private and other gov’t sectors.
roles.
 Information sharing and areas of coverage among partners.
 Identification of gaps in specific areas and taking
intervention.
 Reviewing, adopting strategies and guidelines.
 Proposing area for policy improvement.
 Submitting report to H sector coordinating committee.
Provincial.
 Provincial administrative reforms.
roles.
 Coordinate and supervise roles of district.
 Training of DHMT on community strategy issues.
 Training of level 4 and 5 hospitals on community strategy issues.
 Supportive supervision.
 Provincial planning and writing reports and giving feedback.
 Monitoring and evaluation projects.
 Financial and commodity Mnx.
 Infrastructure and logistics Mnx.
 Operational research.
H sector coordination committee.
 Made up of 20 members. Chair is the permanent secretary.
 Members are head of the department of all ministries like eg
education finance water NGO, FBOs…..
roles.
 Approving and adopting of annual operational plans.
 Reviewing and developing H sector policy documents.
 Mobilization and allocation of resources.
 Facilitating, harmonization and alignment of plans to the joint
programs and of work of funding.
Life cycle cohort.
 We have 6 life cycle cohort.
 Pregnancy and newborn up to 2 wks
 Early childhood- 2wks up to 5yrs
 Late childhood-5-12yrs.
 adolescent- and youth 13-24yrs
 Adulthood 25-59yrs.
 Elderly 60 and above.
Pregnancy and newborn up to 2wks.
 Service at level one- community.
 IEC materials on early recognition danger signs, birth preparedness , H

promotion, community midwifery and referral.

lever 2 and 3.
 Focused antenatal care.

 basic obstetric care.

 Post abortion care.

 Maternal death reviews.

 Ptmtc.

key H message of level one.

Recognize warning signs in pg and childbirth and getting immediate skilled help.
Remind the community that physical abuse of women for any reason is
unacceptable.
CONT……….
 Encourage pregnant women to go for ANC.
 Use ITNs.
 Have birth plan.
 Encourage mothers to get immunized against TT.
 Immunization in newborns.
 Exclusive breast feeding per the first 6 months.
 Involve fathers in reproductive H of the community.
early childhood.
 Care of sick children.
 Service seeking and compliance.
 Promote growth and development.
 Community dialogue and action days.
 Any referral services.
Level 2 and 3.
 Immunization, growth monitoring, rx of community condition, essential
drug supply and referral services.
key messages.
 Give all children vit A supremeness.
 Monitor growth every month.
 Recognize warning signs of child growth and development.
 Good nutrition.
 Family to provide affection to ensure social development of child is
complete.
 Provide exclusive breast feeding.
 Keep child H card.
 H education in brushing teeth, ITN and clean water.
 Involve father in care of children.
LATE CHILDHOOD 5-12YRS.
 School attendance.
 Encourage attendance and support behavior changes and formation, hygiene ,
safe water and ITnS.
Level 2 and 3.
 Screening early detection of H problems.
key H messages.
 Ensure they receive adequate balanced diet.
 Give psychological support.
 Seek H care and illness support as is expected.
 Insist sleeping under ITNs.
 Taking treated water.
 Teach them to wash hands.
 Introduce sexuality education at focal points like school, churches and homes.
Adolescents and youth 13-24 yrs.
 At level one.
 Behavior change and community.
 Peer educating and information.
 Supply of preventive commodities.
 Referral services.
 Systemic Mnx of STIs and lab investigations.
 Referral services.
Key H messages.
 Seek H care or illness appeal as per expected.
 Sleep under ITNs.
 Use treated drinking water.
 Remember that abstinence is the safest way to prevent HIV AND
STIs.
 Delay sexual engagement as long as possible.
 Use protection during sex.
 Follow all instructions given at the H facility.
 Avoid use of alcohol, cigarettes and drugs.
 Involve both parents in care of the adolescent.
 Encourage parents to discuss sexuality issues with their adolescents.
 Prevent unwanted pgs thro’ use of FP services.
Adult hood 25-59.
 Level one.
 Use of IEC methods of teaching.
 Behavioral change and community
 Home care and rx compliance.
 Supply of preventive commodities.
 Water sanitation.
 Promoting of gender and H right and referral systems.
level 2 and 3.
 IEC material behavioral change.
 ICT and ART support.
 Symptomatic rx of common conditions.
 Essential drug supply.
 Referral services.
Key messages.
 Remember all ppl are at risk of HIV/AIDS infection thus
condom use.
 Reduce risk of getting HIV via sex by not having sex at all
times or being faithful to one partner.
 Discuss sexuality with children early enough.
 Get information on lifestyle related illness.
 Check regularly for non communicable dzz like DM and
HTN.
 Seek H care as soon as illness is suspected.
 Sleep under ITNs.
 Drink treated water.
Elderly 60 and above.
 Behavior change and communication to reduce harmful practices.
 Referral system.
level 2 and 3.
 Mnx of rehabilitation and clinical problems.
 Screening and detection of dzz and doing referral.
 Behavior change.
key Mnx.
 Seek H care as soon as illness appears or is suspected.
 Use ITN and treated water.
 Follow instructions given at the H facility.
 Take regular exercise.
 Go for regular medical check up.
CONT……..
 they do need assistance thro’ research then go to gov’t to be
given go ahead together with community they plan and give
feedback
 Govt shd be awear of any project or program taking place in

the community.
teams and team building.
Team is a group of 2 or more ppl with some interest towards
achieving a certain goal. Teamwork is the foundation of success.
Stages of team development.
 Forming- it is orientation and acquaintance.
 Storming- individuals personalize
 Norming- conflict development during storming are resolved
and on the team unit.
 Performing- team members focus on problem solving and
accomplish there task.
 Addowning(finish) members prepaid for dispesement. Every
individual is alone.
TYPES OF TEAMS.
 Formal teams- created by organization as port of organizational
structure. Like DHMT.
 Vertical team- formal team composed of manager and his
subordinates. There is chain of command.
 Horizontal team- a formal team compose of employees of the
same level with different expertise like nurse and Cos.
 Committee teams- are team that deal with tasks that occurs
regular.
 Special purpose teams- created outside organizations to undertake
special programmes.
 Self directed team- consists of 5-20 members, rotate on their role
and supervise by there leaders.
Evaluation and monitoring.
 Monitoring is a continuous process of following unplanned
activities to identify any deviation and address them
immediately for purpose of attaining the goal.
importance of monitoring.
 To follow up progress.
 To analyze r/ship btn output and input.
 Ascertain that method and strategy used are appropriate.
 Enable project personnel to plan effectively.
 Motivate community and staff involved.
Indicators of monitoring.
 Population profile.
 Births and deaths.
 Household visited.
 Dzz incidence.
 Use of services like ANC and immunization.
 Availability of latrines.
 Rx of water points.
 Use of ITNs.
Evaluation.
 It is a scientific based analysis of information about a
program.
 The purpose is to determine if the intended goal has been
affectively achieved.
 Evaluation is time bond meaning it takes place at certain
point.
 It enables one to identify successful strategy.
 Modify and discontinue interventions that donor yield results.
 Share findings with other stake holders.
 Provide donors with evidence of the result of the investment
and demonstrate accountability.
Importance of evaluation.
 Check for effectiveness teach and method used.
 Establish bond making for determining achievements and
appropriate interventions.
tools used.
 Reports, daily results, checklists, daily register, focused group
discussion, observation using the 5 senses.
referral system.
 It is a interlinked network of services provider and facility that
provide a continuous of care for acute and chronic illness.
 There are 4 levels of H referral network.
 Community. -secondary
 Primary -tertiary.
CONT……..
 The house hood care givers CHW and CHEWs be trained to
recognize illness and gauge its severity and in order to provide
referral in time.
objectives of referral.
 Improve the asses of client to H services.

 Reduce the time it takes to get to the next level.

 Avoid unnecessary delays.

 To achieve theses activities the following shd be done:

 Formal referral arrangement.

 Proper communication and availability of transport.

Essential elements for referral
system.
 Service availability- availability of services at next winch are accessible
and affordable to the community.
 Coordination of referral activity- CHW shd coordinate referral activity
in community and provide feedback.
 r/ship- the referral 3 facilities shd take the lead in establishing and
maintaining records.
 Communication and transport- they are crucial for effective referrals
identifying the cheapest means of transport and community members
can assist .
 Feedback mechanism- a good feed back system shd be established to
help track referrals.
 Monitoring and evaluation- referral system shd be included in the
monitoring and evaluation to ensure continuous referral.
Steps in referral process.
 It shd be done thro’ dialogue btn services provider and the client.
 Assessment need- discuss with the client to identify their immediate need.

 Determine attentives- discuss what the client shd do to reach the next level.

 Identify option- discuss with both the client and the care giver to come up

with other opinions.

 Appraise the options- select doable option or appropriate.

 Commit to action- discuss consequences taking and not taking the agreed

action.
 Develop a plan of action- map out what is to be done and feel out the

referral document.
 Take action- more on the option as planned and follow up.

 Asses the action and provide feed back thro’ regular meetings and inform

the care givers.

Emergency support system.
 There is money set aside for emergency response both in
central gov’t and county gov’t.
 This money is used up in case of disaster or outbreak.
 Community shd be encouraged to have emergency kit.