oruIn 2006, the Community Health Strategy was developed and launched to strengthen community health activities in Kenya. In the strategy, a community unit (CU) composed of CHWs, community health extension workers (CHEWs), and community health committee (CHC) is defined as Level-1 health service delivery unit. In the strategy revised in 2010, monthly remuneration for CHWs was newly proposed with Siaya County becoming the first County to adapt and pay stipends to the CHWs, and the standard number of households covered per CHW increased from 20 to 100.

In Siaya County, CHWs undertake regular household visits for the purpose of: (i) Management of Covid-19 through key messaging and health education, and providing health education sessions at each household; (ii) identifying women having danger signs during pregnancy and other households members’ health problems; (iii) referring them to the health facility linked to the CU; (iv) monitoring patients’ recovery process at households; and (v) collecting updated households’ demographic and health data. They were not authorized to provide household members with any treatments.

On September 8th 2020, the Kenya Ministry of Health (MOH) reported a total of 35’356 COVID-19 cases and 599 deaths due to COVID-19 (1). In the last 3 months, to respond to the COVID-19 pandemic, we deployed community health workers (CHWs), equipped with mobile technology through several training on Covid-19 management and control measures. They visited households’ door to door to screen community members for symptoms of COVID-19, isolate, test, and manage suspected cases of COVID-19. Symptomatic testing was performed at home (by the Siaya rapid response team) and in health facilities (by clinicians). CHWs and the nyumba kumi initiative educated households about preventive measures including frequent handwashing, universal mask wearing (indoors when visitors are present and outdoors), and home management of mild cases. Simultaneously, we worked with nurses and doctors to build their capacity in infection prevention and control measures, and the care of severe cases of COVID19 in health facilities.

To date, Siaya with a population of 993’000, has had 86 confirmed cases of COVID-19 and 4 deaths since the pandemic was declared on March 11th 2020 (2,3). Fifty-nine of the cases were asymptomatic. This model worked for Siaya County most appropriately.

Our approach has been unique in its comprehensiveness, its integration of activities from the community to the health system, its responsiveness in addressing needs of Siaya communities, CHWs and clinicians, and in the true partnership that has developed with the Siaya county MOH with systems integration. In the coming months, we will continue to reinforce critical components of the intervention and follow key indicators in preparation for a potential surge in cases as schools reopen and movements between hotspots and Siaya continue.

By Ken Oruenjo
County Director Public Health Sanitation and Health Planning.