“Volunteerism is not an easy task,” she said. “I know we cannot be paid fully, but a [small payment] so that when we are in the field, we feel encouraged by doing this work.”
The role of development partners, community health volunteers
It’s clear the government won’t be able to achieve UHC alone. So development partners such as Smile Train have stepped in to help — signing partner agreements and providing funding to partner hospitals so that patients don’t pay for treatment out-of-pocket. It also provides the services of trained surgeons, training opportunities to local health workers, anesthesia protocols geared toward ensuring safety and quality of care, and anesthesia equipment. The organization also offers transportation funds for patients that cite the cost of traveling to the hospital as prohibitive of receiving treatment. This partnership helps the government reach the last mile patients, according to Njoroge-Muriithi.
“When you look at overall health care, even under universal health coverage, there’s a lot of focus on public health, primary health care, disease prevention and treatment. But there is very little mention of surgical services,” she said.
At the Kisumu County Referral Hospital, Ramsey Onyango receives surgery to correct a cleft lip. The free surgery is made possible through a partnership between Smile Train and Kenyan non-profit the Bela Risu Foundation.
Community health volunteers, such as Nguta, also play a key role in identifying patients at the community-level and referring them for services, as was the case with her role in encouraging Brighton’s family to go through with the surgery.
“Community health workers in Kenya are the community ‘doctors’ known and trusted by their village communities,” Njoroge-Muriithi said.
But a key inhibitor of this is that many county governments aren’t paying these health workers, and the job is considered volunteer work, Nguta said. This makes it difficult for them to spend time on community outreach while they also try to manage expenses at home. Nguta is also a farmer.
Compensation for community health volunteers varies county by county. Kisumu County, for example, recently decided to pay its health volunteers about $20 in a stipend per month, according to a county government press release. Sometimes NGOs provide small stipends for specific tasks, such as follow-up of chronic conditions and data collection, according to Njoroge-Muriithi. Smile Train provides usually between $5 and $10 to community health volunteers for identifying patients for treatment and any follow-up to help pay for their time, as well as transport and mobile phone costs.
Whether payment for community health volunteers will be included in the national rollout of UHC is still undecided. An upcoming bill that a group of legislators plan to introduce to the National Assembly could change that. It would require county governments to pay its community health workers, according to Senator John Kinyua.
As the country rolls out UHC, ensuring these health workers are empowered will be a deciding factor as to whether the country is successful, Mulwa noted.
“You need them in the right numbers, with the right skills, with the right motivation, and in the right place, at the right time,” he said.