A passion for community health
When Mathew Abuto first started working for the Nyamira County Government as a Monitoring and Evaluation Officer over 14 years ago, he saw worrisome trends in county health data that were impossible to ignore.
Limited coverage of essential services, such as HIV testing among pregnant women and low adherence rates for HIV and tuberculosis (TB) treatment, meant that a large proportion of the county population was not getting the care they needed to stay healthy and thrive.
Even today, Nyamira County is among the counties in Kenya with the highest HIV burden, with an estimated HIV prevalence of 3.5 percent. Rising HIV transmission, especially among children and adolescents, coupled with a high TB-HIV coinfection rate of 25 percent, continue to point to missed opportunities to provide HIV and TB testing, treatment, and care.
People living with HIV and/or TB also face other challenges, such as stigma and limited access to health education, leading to limited health-seeking behavior, late diagnosis, poor adherence to treatment, and ultimately, poor health outcomes.
A desire to tackle these challenges led Mr. Abuto to take on the role of Community Health Services Coordinator in Borabu subcounty, the largest subcounty in Nyamira. In this role, he began working directly with community health promoters (CHPs) to improve access to health services within communities and strengthened linkages to follow-on care at heath facilities. He also established 7 Community Health Units (CHUs), responsible for coordinating and supervising CHPs.
His early work with CHPs focused on improving their ability to deliver health education, locate and re-engage people who had discontinued or interrupted their treatment, refer community members to health facilities, and report on health indicators.
The results of this work have inspired Mr. Abuto, who has since risen through the ranks to become the Community Health Services Coordinator for Nyamira County.
Policy changes, persistent challenges
Since Mr. Abuto first began working in Nyamira County, Kenya’s community health strategy has evolved, in growing recognition of the crucial role that community health plays in enhancing access to and uptake of HIV, TB, and other health services.
Kenya's recent health reforms include improving access to high-quality and sustainable health care by revitalizing and focusing service delivery around the primary health care platform, which focuses on health promotion, preventive care, and management of common diseases.
Reforms include re-organizing service delivery models into Primary Care Networks, with CHUs forming the foundation of Primary Care Networks and a robust community health system. Since the early 1980s, although they provided valuable health services, CHPs in Kenya were engaged on a voluntary basis.
Through recent policy changes, including an amendment to the county’s Community Health Services Act of 2022, the Nyamira County government has developed a policy framework to recognize, professionalize, and incentivize CHPs, including provision of monthly stipends from the county’s health budget.
However, CHPs and CHUs continue to face many challenges in delivering high-quality services. The number of CHPs adequately trained to deliver HIV and TB services is unacceptably low, and many lack the equipment and skills needed to record, monitor, and report on their work using Kenya’s new electronic Community Health Information System (e-CHIS).
Mathew Abuto, Community Health Services Coordinator, Nyamira County. Photo: PATH/Caroline Wangire.
Catalyzing community health efforts
To address these challenges, with support from the Astellas Global Health Foundation (AGHF), PATH is working hand-in-hand with the government of Nyamira County to strengthen community health systems. This includes training and mentoring the community health workforce, providing digital equipment and training, improving supply chains, and advancing policy to operationalize and sustain health care reforms.
These activities have been catalytic for overall government efforts in Nyamira County, and rekindled Mr. Abuto’s hope to improve health outcomes for the county’s population of approximately 700,000.
Earlier this year, AGHF support allowed one of Mr. Abuto’s colleagues to participate in a workshop to review the national HIV and TB training curriculum for CHPs. In Nyamira, PATH and partners will use this curriculum to train 1,440 CHPs with the skills and knowledge to provide integrated HIV and TB services within communities.
PATH also procured 207 new tablets and smart phones to facilitate reporting by CHUs. Having access to tablets and smartphones is crucial to Kenya’s broader efforts to digitize community health reporting through the national e-CHIS platform. They will enhance real-time reporting and empower community health teams to make timely and informed decisions for client care.
Within the Nyamira County government, Mr. Abuto has championed these efforts as well as other PATH-supported initiatives, including the establishment of e-CHIS help desks to provide service and trouble-shooting support to users in real time, and a county asset management system that lists and tracks all IT devices.
“This support came at a time when the county was intentional in revamping community-level HIV and TB service delivery to complement care and treatment work in health facilities.”— Mathew Abuto
A bright future for universal health coverage
Mr. Mathew Abuto is elated as he reflects on the progress that the AGHF-supported collaboration with PATH has enabled. With PATH’s approach to strengthening community health systems to provide integrated HIV and TB services in Nyamira, Mr. Abuto foresees a future in which individuals living with HIV and TB have access to a wide range of health care services, ultimately resulting in happier and healthier lives.
Incorporating community HIV and TB services into the county’s primary health care system is a transformative and sustainable approach, aligning with Kenya’s universal health coverage agenda.
