OMETE: Let’s find ways to reward community health workers

As the deficits of the health system appear to become prominent, workaround to the solution especially for rural health systems needs primary healthcare with lots of input from community health workers (CHWs).

A shift in name from Community Health Volunteers or CHVs to CHWs followed the realisation that volunteerism on a fulltime taxing role is impractical. The new name, CHW is in itself a misnomer as it implies CHWs are being paid as “workers”.

Looking across most countries relying on CHWs for delivery of health services, no single one has successfully implemented a working and sustainable CHW remuneration strategy—one of the obstacles being the sheer number of this critical yet overlooked primary health system resource. The other one is our refusal to acknowledge their importance.

The Kenya Community Health Strategy for 2014-2019 is a good starting point towards addressing this, but it falls short of providing “the how” and “the who: two critical components of arriving at this solution.

Is there a role for the private sector to play in developing answers on how to go about this?

Most governments all over the world have the best intentions for their citizens, their actions however do not always support this fact. Solving problems is often hampered by governments’ bureaucratic operational models. Here is where the private sector can make a difference.

As agile innovative entities operating on “lean and mean” models, sustainability is a key ingredient for many of the solutions the private sector develops. It also tests multiple models to gain insights more rapidly.

Using these metrics, this group is in a better position to suggest approaches to the governments towards solving this conundrum. In Kenya given the variance in the 47 counties geographical areas, demographics, cultures as well as socioeconomic activities, no one solution will work for everyone.

Each region requires a distinct approach with localised currency.

What the private sector health stakeholders need is a challenge innovation fund to design mutually beneficial approaches that gainfully reward CHWs while improving their measurable productivity.

To begin with, potential beneficiaries of CHWs output should invest in this challenge fund. This could either be facilities in the private sector either faith based or NGO supported. One glaring yet basic tasks that CHWs can actively be involved in is health information and collection system. Data entry and collection particularly in the public sector could be improved.

Similarly, Water Sanitation and Hygiene (WASH) programmes are always focal areas for CHWs activities. This cuts across both urban and rural areas. Another sector is the environmental and infrastructure players that could benefit from more detailed information for their projects and activities.

A personal commitment is also needed from all of us to prioritise opportunities to this important but overlooked group in our society.