Introduction to the Community
Strategy
• Communities are at the foundation of affordable, equitable and effective health care. The community, i
fact, represents level 1 in the Kenya
• Essential Package for Health (KEPH) proposed in the second National Health Sector Strategic Plan 2005–
(NHSSP II). It is so important to the success of NHSSP II that a specific strategy was developed for rolling
the strategic plan at community level: Taking the Kenya Essential Package for Health to the Community:
Strategy for the Delivery of LEVEL ONE SERVICES1 (hereafter referred to as the Community Strategy).
• The overall goal of the Community Strategy is to enhance community access to health care in order to
improve individual productivity and thus reduce poverty, hunger, and child and maternal deaths, as wel
improve education performance. This goal is to be accomplished by establishing sustainable level 1 serv
aimed at promoting dignified livelihoods across all the stages of the life cycle, and throughout the coun
through the decentralization of services, as well as enhanced accountability and responsibility among a
concerned partners.
• The community-based approach, as set out in the Community Strategy, is the mechanism through whic
households and communities strengthen their role in health and health- related development by increa
their knowledge, skills and participation. The intention is to strengthen the capacity of communities to
assess, analyse, plan, implement and manage health and health-related development initiatives so that
can contribute effectively to the country’s socio-economic development. The approach recognizes that
communities are already actively engaged in health activities for the survival of their households. Their
actions for health could be strengthened through an increased knowledge and skills base as well as by b
planning of their activities.
,• In addition, the approach recognizes the pivotal role of the health system in supporting
community efforts. It is through partnership between the system and the communities that
improvement can be realized and sustained.
• It is therefore critical to integrate level 1 health activities by all stakeholders into the health c
system. The integration requires mechanisms and structures that provide the necessary linka
Such structures would enhance and enable effective participation of communities in health-
related decision making processes at the community level, as well as at the interface betwee
level 1 and levels 2 and 3. This is the intention of the decentralization policy that is key to Ken
ongoing health sector reform, NHSSP II and KEPH.
• The Community Strategy spells out the linkage structures at district, divisional, health facility
community levels that are expected to provide citizens with sufficient representation and voi
all issues affecting service provision at level 1. The health facility in-charges (support- ed by th
district health management team – DHMT), community health extension workers (CHEWs),
community health workers (CHWs), village elders and chiefs, and other extension workers are
sinews that bind these structures and enable sustained community leadership in addressing
health problems, through the formation of linkage committees at all these levels.
• Since this is a new approach, health care managers and providers accustomed to the older to
down way of operating may require insights into how to make the strategy work. This volume
therefore spells out the guidelines for ensuring the equitable and effective operation of the
Community Strategy. This introductory chapter presents the objectives and purpose of the
guidelines and how the book is organized.
,1.1 Objectives of the Community Strategy Guidelines
The Community Strategy intends to improve the health status of Kenyan
communities through the initiation and implementationof life-cycle focus
health actions at level 1. This document provides guidelines for:
• Establishing community health service linkage structures through effect
decentralization and partnership for the implementation.
• Launching and managing the Community Strategy.
• Building the capacity of the community health extension workers (CHEW
and community health workers (CHWs) to provide services at level 1.
• Establishing a communication strategy that effectively improves health
seeking behaviour.
• Providing level 1 services.
• Establishing mechanisms for evidence-based dialogue informed by
community and facility- based information systems.
, 1.2 The Purpose and Overview of the Guidelines
• These guidelines target frontline managers, including district managers, responsible for enhancing the
linkage between the health system and the communities. The target group includes the frontline manag
from the district health managers to the sub-district down to local levels who have the task of oversight
the linkage structures and their functions as well as support for service delivery at levels 1, 2, 3 and 4. It
includes the CHEWs, and members of the linkage structures, including local leaders at community and
administrative structures.
• 1.2.1 Why the Guidelines
• Because most service providers act top-down according to training and experience, they may not have g
an alternative approach adequate consideration. For this reason, not all professionals will have the
necessary skills to work with clients, households and communities as partners rather than simply recipi
of services. These guidelines intend to help facilitators and managers work within the proposed partner
approach to enable clients, households and communities to increase their control over their situation
through more informed and effective actions.
• In this way the guidelines hope to empower both communities and providers to improve health at the
frontlines, working as partners in action. The communities will also be able to exercise effective demand
quality care, with mutual accountability and responsibility for better health for all across all cohorts. Thi
be achieved through community—health system linkage, enhanced ownership of facilities, enhanced
community control and greater personal responsibility for health. The guidelines describe the processes
structures for including communities in the governance of health facilities and related resources. This w
increase people’s self-esteem, capacity for informed dialogue and control. The guidelines introduce and
strengthen the culture of assessment, dialogue, planning and action throughout the country to ensure
sustained improvement at level 1.
Strategy
• Communities are at the foundation of affordable, equitable and effective health care. The community, i
fact, represents level 1 in the Kenya
• Essential Package for Health (KEPH) proposed in the second National Health Sector Strategic Plan 2005–
(NHSSP II). It is so important to the success of NHSSP II that a specific strategy was developed for rolling
the strategic plan at community level: Taking the Kenya Essential Package for Health to the Community:
Strategy for the Delivery of LEVEL ONE SERVICES1 (hereafter referred to as the Community Strategy).
• The overall goal of the Community Strategy is to enhance community access to health care in order to
improve individual productivity and thus reduce poverty, hunger, and child and maternal deaths, as wel
improve education performance. This goal is to be accomplished by establishing sustainable level 1 serv
aimed at promoting dignified livelihoods across all the stages of the life cycle, and throughout the coun
through the decentralization of services, as well as enhanced accountability and responsibility among a
concerned partners.
• The community-based approach, as set out in the Community Strategy, is the mechanism through whic
households and communities strengthen their role in health and health- related development by increa
their knowledge, skills and participation. The intention is to strengthen the capacity of communities to
assess, analyse, plan, implement and manage health and health-related development initiatives so that
can contribute effectively to the country’s socio-economic development. The approach recognizes that
communities are already actively engaged in health activities for the survival of their households. Their
actions for health could be strengthened through an increased knowledge and skills base as well as by b
planning of their activities.
,• In addition, the approach recognizes the pivotal role of the health system in supporting
community efforts. It is through partnership between the system and the communities that
improvement can be realized and sustained.
• It is therefore critical to integrate level 1 health activities by all stakeholders into the health c
system. The integration requires mechanisms and structures that provide the necessary linka
Such structures would enhance and enable effective participation of communities in health-
related decision making processes at the community level, as well as at the interface betwee
level 1 and levels 2 and 3. This is the intention of the decentralization policy that is key to Ken
ongoing health sector reform, NHSSP II and KEPH.
• The Community Strategy spells out the linkage structures at district, divisional, health facility
community levels that are expected to provide citizens with sufficient representation and voi
all issues affecting service provision at level 1. The health facility in-charges (support- ed by th
district health management team – DHMT), community health extension workers (CHEWs),
community health workers (CHWs), village elders and chiefs, and other extension workers are
sinews that bind these structures and enable sustained community leadership in addressing
health problems, through the formation of linkage committees at all these levels.
• Since this is a new approach, health care managers and providers accustomed to the older to
down way of operating may require insights into how to make the strategy work. This volume
therefore spells out the guidelines for ensuring the equitable and effective operation of the
Community Strategy. This introductory chapter presents the objectives and purpose of the
guidelines and how the book is organized.
,1.1 Objectives of the Community Strategy Guidelines
The Community Strategy intends to improve the health status of Kenyan
communities through the initiation and implementationof life-cycle focus
health actions at level 1. This document provides guidelines for:
• Establishing community health service linkage structures through effect
decentralization and partnership for the implementation.
• Launching and managing the Community Strategy.
• Building the capacity of the community health extension workers (CHEW
and community health workers (CHWs) to provide services at level 1.
• Establishing a communication strategy that effectively improves health
seeking behaviour.
• Providing level 1 services.
• Establishing mechanisms for evidence-based dialogue informed by
community and facility- based information systems.
, 1.2 The Purpose and Overview of the Guidelines
• These guidelines target frontline managers, including district managers, responsible for enhancing the
linkage between the health system and the communities. The target group includes the frontline manag
from the district health managers to the sub-district down to local levels who have the task of oversight
the linkage structures and their functions as well as support for service delivery at levels 1, 2, 3 and 4. It
includes the CHEWs, and members of the linkage structures, including local leaders at community and
administrative structures.
• 1.2.1 Why the Guidelines
• Because most service providers act top-down according to training and experience, they may not have g
an alternative approach adequate consideration. For this reason, not all professionals will have the
necessary skills to work with clients, households and communities as partners rather than simply recipi
of services. These guidelines intend to help facilitators and managers work within the proposed partner
approach to enable clients, households and communities to increase their control over their situation
through more informed and effective actions.
• In this way the guidelines hope to empower both communities and providers to improve health at the
frontlines, working as partners in action. The communities will also be able to exercise effective demand
quality care, with mutual accountability and responsibility for better health for all across all cohorts. Thi
be achieved through community—health system linkage, enhanced ownership of facilities, enhanced
community control and greater personal responsibility for health. The guidelines describe the processes
structures for including communities in the governance of health facilities and related resources. This w
increase people’s self-esteem, capacity for informed dialogue and control. The guidelines introduce and
strengthen the culture of assessment, dialogue, planning and action throughout the country to ensure
sustained improvement at level 1.
