By Dr. Sheila Njuguna
The health sector reforms in Kenya, are set against a backdrop of complex epidemiological, socio- economic, and political factors. These dynamics almost always pose intricate challenges in the delivery of healthcare services and in meeting the diverse needs of the population.
Over the years, the Government of Kenya, with the support from various stakeholders, has continued to develop and implement national health policies and initiatives aimed at achieving Universal Health Coverage (UHC). These efforts focus on expanding access to quality and affordable healthcare services for all Kenyans. While notable progress has been made, health inequities continue to limit the full realization of UHC, particularly among marginalized and underserved populations.
The promulgation of the 2010 Constitution, marked a major shift in Kenya’s governance structure by the introduction of a devolved system of governance, consisting of two-tier government system mainly, the County and the National government. The goal of devolution was to enhance utilization and geographical access to quality care for all Kenyans more so addressing the disparities affecting the poor and other vulnerable groups. Ultimately, this governance reform aimed to promote health equity across the country.
Despite the considerable milestones, equity related issues have riddled the UHC implementation process. These challenges are largely attributed to a weakness in health system governance including variations in infrastructure and human resource capacities, resource allocation inefficiencies, and gaps in accountability mechanisms, resulting to disparities in health outcomes and service delivery.
The enactment of the Primary Health Care Act, 2023 was another important milestone towards strengthening the health system. The Act’s seeks to ensure all Kenyans have access to essential health services, with keen attention on community-based healthcare. Its key objectives being to expand access to primary health services while promoting preventive and promotive care at the community level. Thereby, improving health outcomes while strengthening community health systems.
Why Addressing Health Disparities Is Important?
Health disparities in health status and healthcare delivery, are important from an equity standpoint. Ethnic and geographical differences considerably have an influence on health outcomes and are closely linked to social, economic, and environmental disadvantages. These disparities result in higher rates of illness and mortality, reduced productivity and substantial economic losses, with the greatest impact felt among vulnerable communities.
Addressing health disparities requires clear identification of the specific gaps in health outcomes, with a laser focus on marginalized populations. This can be achieved by engaging community health workers/volunteers to conduct comprehensive Health Needs Assessment across different regions. Such assessments should take into consideration the cultural background including social beliefs, perceptions and societal attitudes towards healthcare.
By comprehending cultural norms surrounding health practices, stakeholders can design culturally appropriate, feasible and successfully tailored health policies, initiatives and strategies that respond directly to the community needs and that ultimately improve health outcomes and promote health equity.
The Role of Community Engagement
Community engagement involves including local people in planning, implementing, and evaluating health programs. Community Health Workers/Volunteers (CHW/Vs) have always played a pivotal role in advancing health equity in Kenya. Their contribution has been majorly in community health interventions especially in maternal and reproductive health, child health, malaria prevention and HIV/AIDS programs. By serving as a link between communities and the formal health system, CHW/Vs ensure that health services are responsive to local needs.
Additionally, involving communities in the development of health initiatives and interventions, ensures that solutions are co-created with those who are most affected. This participatory approach helps to build trust and promote interventions that are culturally appropriate, sustainable, and more likely to be effective. Furthermore, embedding research into the fabric of community health initiatives helps bridge the gap between evidence and practice creating a healthcare system that is both innovative and responsive to the specific needs of its most vulnerable citizens.
Navigating health equity requires a multisectoral collaboration and meaningful community engagement to align interventions with community priorities, leverage shared resources, and achieve sustainable, inclusive health outcomes.
References
- Davis, E. C., Arana, E. T., Creel, J. S., Ibarra, S. C., Lechuga, J., Norman, R. A., Parks, H. R., Qasim, A., Watkins, D. Y., & Kash, B. A. (2018). The role of community engagement in building sustainable health-care delivery interventions for Kenya. European Journal of Training and Development, 42(1/2), 35–47.
- Ilinca, S., Di Giorgio, L., Salari, P., & Chuma, J. (2019). Socio-economic inequality and inequity in use of health care services in Kenya: Evidence from the fourth Kenya Household Health Expenditure and Utilization Survey. International Journal for Equity in Health, 18(1), 196.
About the Author
Dr. Sheila Njuguna is an Occupational and Global Health Specialist.
Co-Convenor of the Policy, Advocacy and Communications Committee
