Community systems strengthening (CSS) are essential to ensuring that health programs are comprehensive and responsive, in particular to the needs of marginalized groups and community in general, health experts and Civil society organizations said during the 2nd Amref Health Africa in Kenya National Community Systems Strengthening Knowledge Dissemination Forum.
According Amref health Africa in Kenya, the Community Systems Strengthening approach shifts focus from treating people as “recipients” of services to being active catalysts, who can partner with public and private organizations to address complex problems like health equity, product shortages and violations of rights when accessing care.
Benson Ulo from AMREF Health Africa Kenya underscored the role of community systems strengthening in TB, HIV, and malaria program saying that it promotes resilient and sustainable health systems.
According to Ulo, “Community System Strengthening program aims to increase access to health and social services, build strong community linkages and networks and strengthen coordination within Kenya Global Fund program and its interface with all other stakeholders.”
Benson Ulo spoke at the 2nd Community Systems Strengthening meeting convened by Amref Health Africa Kenya and Stop TB Partnership themed “Showcasing Innovative Approaches and Best Practices in CSS Intervention” which highlighted best practices and lessons learned in Community System Strengthening (CSS) and give communities a platform to learn from their peers. The forum led by Amref Health Africa in Kenya under the Global Fund TB project.
“Community systems strengthening (CSS) involves building informed, capable, and coordinated communities and community-based organizations. Scaling up advocacy, communication, and social mobilization (ACSM) crucial for TB elimination and reversing HIV/AIDS trends. CSS focuses on capacity building and strengthening resources to enable communities to play an effective role in health and social welfare systems, ensuring sustainable interventions and an enabling environment,” Ulo said.
He adds that The Global Fund developed a set of Measurement Frameworks that cover HIV/AIDS, Tuberculosis, Malaria and Health System Strengthening other key areas of focus are Community-Led Monitoring, Community-Led Advocacy and Human Rights and Gender Integration.
Community-led monitoring ensures accountability and quality service delivery, while community advocacy and research mobilize resources and evidence-based decision-making.
The focus of the forum is community involvement, capacity development, and advocacy to improve health outcomes and service delivery at the community level.
In Kenya, vulnerable and marginalized populations face barriers to accessing TB and HIV services due to stigma, discrimination, and violence. Community engagement and systems strengthening are essential for overcoming these barriers and achieving health equity.
Community involvement in TB response is crucial to its elimination because it is a social phenomenon with severe health implications for the whole population. Communities are the ones that understand ‘how’ to deliver services effectively and to reach marginalized and other affected population groups.
For example, Monica Adoyo Adipo, a facility link assistant in the Nyamninia community health unit in Siaya County, plays a vital role in tuberculosis (TB) contact tracing and drug defaulter tracing. Supported by Global Fund through Amref Health Africa Kenya and their grant sub-recipient IRDO, Monica conducts daily household visits to screen individuals exhibiting TB symptoms such as coughing, headaches, restlessness at night, high body temperature, and fatigue.
Upon identifying a potential TB case, Monica instructs the person to visit the nearest public healthcare center for TB testing and treatment. At the hospital, patients diagnosed with TB are put on medication, and Monica follows up with household members to ensure their health status is assessed. She educates families on living with TB patients, emphasizing nutrition and reducing stigma and discrimination.
Monica advises households of TB patients to get tested and, if found negative, to take TB Preventative Therapy (TPT) to avoid infection. Adults take a weekly pill for three months, and children under five follow a similar regimen. She uses Referral MoH 100 for screening and refers symptomatic individuals to hospitals where lab tests determine their TB status.
Despite the challenges, such as patients’ nutritional needs and socioeconomic vulnerabilities, Monica finds motivation in the improvements and adherence to TB treatment within her community. She frequently encounters patients unable to take their medication on an empty stomach, prompting her to provide food from her own resources.
Monica’s dedication is evident in her persistence with treatment interrupters, ensuring they return to and complete their TB medication. Success stories, such as helping a child diagnosed with TB recover, bring her immense satisfaction.
As a community TB facility link implementer, Monica receives a stipend from AMREF Health Africa Kenya and other supporting partners.
Chief national coordinator for Stop TB Partnership Kenya, Evelyne Kibuchi, highlights TB as a significant public health issue in Kenya saying that community engagements coupled with medical and advocacy interventions have contributed to a reduction in TB-related mortality in Kenya from 33,000 deaths in 2019 to 17,000 by the end of 2022 according to latest data from ministry of health.
She adds that community involvement in TB response has led to stigma reduction, and patient support which is crucial in TB elimination.
“Communities support TB continuum of care from diagnosis, through treatment adherence and support they also disseminate TB prevention and risk reduction information in local language that is easily understood by the locals and empower them to be more TB aware.”
Stephen Anguva Shikoli national coordinator network of Tb champions said that TB case findings improved by use of Community health promoters. He explained that the dissemination forum brings people affected with Tb to speak freely of TB therefore offering psycho-social and adherence support to those affected.
Advocate Melba Katindi stressed the importance of civic education and ensuring strict adherence to human rights in improving healthcare access saying that building resilient and sustainable community systems that respond and take into account respect for human rights and gender interventions ensure that everybody is included in the programs.
“Criminalization of a population such men who have sex with men, claw backs of policies and laws around adolescents’ access to contraceptives and abortion services are retrogressive in achieving disease elimination goals.”
She said that the programs offered to the communities shouldn’t be emphasizing gender stereotyping and Civil society organizations advocates for gender inclusions in programs to ensure that no one is left behind in accessing HIV, TB and SRH services.
While Philip Nyakwana of Kenya Coordinating Mechanism for Global Fund emphasized that community-led monitoring, evidence-driven advocacy, and capacity building in responses around HIV, TB, and Malaria, communities are all aimed at building a well informed community so that they are able to collect information and report back to various programs therefore helping in shaping the model of care implementation to the people who are in need.
