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SICILY KARIUKI: Human touch in community health

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The goals of Universal Health Coverage (UHC) are shaping the global health agenda, emphasising that all people, irrespective of socioeconomic status, should have access to health services without incurring financial hardship.

UHC is one of the President’s Big Four agenda. On December 13 he launched the pilot programme in four counties—Kisumu, Nyeri, Isiolo and Machakos. The government targets to realise 100 per cent universal health coverage by 2022, a vision that will be realised by policy and administrative realignments in key health sector institutions.

The community health sub-sector has been strengthened and integrated into the health strategic planning and financed to increase access, and improve quality and affordability of services.

The importance of Community Health Services has been restated in the Kenya Health Policy Framework of 2013-2030 as well as in the Kenya Health Strategic and Investment Plan of 2013-2017. The Community Health strategy was revised in 2014 to respond to the needs of the devolved governments.

Currently the ministry is working with the county governments to develop a Community Health Policy to guide the implementation of community health services.

The main aim of Community Health Strategy is to empower individuals, households and communities to demand services from all providers and to know and progressively realise their rights to equitable, high-quality healthcare as provided for in the Constitution.

To-date Kenya has established 5,309 community health units, which is 55 per cent of total population coverage with a workforce of 97,335 personnel. There are grand plans to establish 4,261 more community health units and recruit a workforce of community health volunteers (CHVs)

Known by a wide range of titles—outreach workers, community health representatives, patient navigators, peer educators, health advocates—community health workers are trusted members of the communities in which they live, sharing common racial and ethnic backgrounds, cultures, languages, and life experiences with the people they serve.

CHVs have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings. Most often, community health volunteers are relied upon to deliver a range of health services directly to communities and link households with the formal health system.

In Kenya, strategic partners such as Living Goods, PharmAccess, Red Cross, Amref Kenya are collaborating with the government to initiate programmes to help CHVs play a significant role in health are delivery and thus a key stakeholder in attainment of UHC. The national and county government’s plan is to empower them with a stipend and a CHV kit that contains basic medical equipment, stationery for data collection, and basic preventive and curative drugs.

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Since the implementation of Community Health Services began in 2008, there has been an improvement in immunisation, antenatal care and reduction of childhood diseases. Cases of non-communicable diseases such as diabetes and hypertension have reduced as a result of intensive screenings and awareness creation.

CHVs have played a critical role in the following three areas: Securing access to healthcare; coordinating timely access to primary care, behavioural health, and preventive services; and helping individuals manage chronic conditions. These may include case identification and recruitment, health education, human service referrals, home visits, client case management that includes follow-up, counselling and other services.

Expanding coverage of key interventions and achieving documented reductions in maternal, neonatal, and child mortality will require approaches that engage the community as partners, empower women and communities, and reach a high proportion of households with health education that encourages healthy behaviours and appropriate use of improved health facilities such as the managed equipment services in counties, free maternity services, and Beyond Zero mobile clinics, among others.

They have the potential to provide health information, encourage healthy practices, and be an accessible point of entry into the national health system for rural and low-income populations. Mobile applications provide an opportunity to address monitoring and supervision challenges by strengthening CHV programs and making them more efficient.

In the words of Daniel Taylor “a community, a family, is a group of people who share common stories. The health of any community depends directly on the health of the stories the community embraces.” It’s the community-partnership approach that helped to reduce Ebola spread in targeted West African communities. The success of preventing Ebola spread in Liberia is attributed to community led engagement to identify, isolate and treat cases.

In Malawi, many improvements in the survival chances of children can be attributed in part to the health promotion work of more than 10,000 health surveillance assistants who are deployed in rural areas. These trained, salaried outreach workers deliver preventive healthcare such as oral immunisations, treat common killers like diarrhoea, pneumonia and malaria, and care for mothers and babies before and after birth.

To achieve UHC and the health SDG targets, long-term community health planning is essential—and along with helping counties identify solutions to meet health goals, it provides an opportunity to evaluate progress and make improvements.

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Public officers above 58 years and with pre-existing conditions told to work from home: The Standard

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Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.

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However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.

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Uhuru convenes summit to review rising Covid-19 cases: The Standard

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President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow

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Drastic life changes affecting mental health

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Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.

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Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.

Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.

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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.

In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020.  It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.

A study by Dr. Habil Otanga,  a Lecturer at the University of Nairobi, Department of Psychology says  that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.

The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.

KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.

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Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.

As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.

“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”

Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.

“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.

Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.

“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”

Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.

“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.

Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.

Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.

She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.

Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.

“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added

Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.

“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and  also engage in   reading that would  help expand their knowledge.

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