By Sharon Onyango
Siaya County is moving to strengthen community health governance, emergency obstetric and newborn care, referral systems and health commodity management following findings from a baseline assessment that identified critical gaps across the health system.
The assessment, undertaken through a partnership between Lwala Community Alliance and the County Department of Health and Sanitation, covered 210 of the 221 Community Health Units (CHUs), representing 95 per cent coverage, and involved 1,251 Community Health Committee (CHC) members.
Findings showed that although community health structures are largely in place, their functionality remains a concern. Only 7.6 per cent of CHCs were fully functional, while 49.5 per cent were semi-functional, 33.3 per cent functional and 9.5 per cent non-functional.
The assessment further revealed a gap between the availability of referral structures and their ability to respond to emergencies. Referral systems existed in 96 per cent of CHUs, with 99 per cent having referral forms. However, only 30 per cent had emergency contact numbers, nine per cent had functional emergency transport and only one per cent had revolving referral funds.
Community participation in facility governance was also limited. Only 31 per cent of CHC chairs were represented on Health Facility Management Committees, while 22 per cent reported holding monthly review meetings. Only 46 per cent used community health data to inform decisions, and just 10 per cent reported participating in stock and commodity monitoring.
Supply chain concerns
The assessment identified significant challenges in health commodity availability, with 89.7 per cent of facilities reporting stockouts.
Critical commodities affected included Ready-to-Use Therapeutic Food (RUTF), with stockouts reported in 100 per cent of facilities, IPTAS tablets at 60.9 per cent, magnesium sulphate at 56.5 per cent, benzyl penicillin at 52.4 per cent and Depo-Provera at 48 per cent.
Weaknesses were also identified in quality and pharmacovigilance, warehousing and storage, financial sustainability, human resources and logistics management information systems.
Proposed interventions include activating the commodity module in eCHIS, creating a CHU commodity dashboard, training pharmacy personnel and CHAs/CHPs on commodity management, strengthening procurement practices and improving storage monitoring.
Strengthening emergency care
The EmONC assessment highlighted inadequate equipment for mentorship, knowledge gaps in neonatal and newborn care, inactive MPDSR committees and weaknesses in referral systems.
Stakeholders proposed provision of essential equipment, targeted EmONC training and mentorship, operationalization of facility MPDSR committees and establishment of functional referral mechanisms.
The assessment provides an evidence-based roadmap for strengthening community health governance, emergency maternal and newborn care and commodity security, with targeted action expected to improve accountability, referral linkages and access to quality healthcare services across Siaya County.