BackgroundDespite focused health policies and reform agenda, Kenya has challenges in improving households’ situation in poverty and ill health; interventions to address the Millennium Development Goals in maternal and child health, such as focused antenatal care and immunization of children, are yet to achieve success. Research has shown that addressing the demand side is critical in improving health outcomes. This paper presents a model for health systems performance improvement using a strategy that bridges the interface between the community and the health system.MethodsThe study employed quasi-experimental design, using pre- and post-intervention surveys in intervention and control sites. The intervention was the implementation of all components of the Kenyan Community Health Strategy, guided by policy. The two year intervention (2011 and 2012) saw the strategy introduced to selected district health management teams, service providers, and communities through a series of three-day training workshops that were held three times during the intervention period.Baseline and endline surveys were conducted in intervention and control sites where community unit assessment was undertaken to determine the status of health service utilization before and after the intervention. A community health unit consists of 1000 households, a population of about 5000, served by trained community health workers, each supporting about 20 to 50 households. Data was organized and analyzed using Excel, SPSS, Epi info, Stata Cal, and SAS.ResultsA number of health indicators, such as health facility delivery, antenatal care, water treatment, latrine use, and insecticide treated nets, improved in the intervention sites compared to non-interventions sites. The difference between intervention and control sites was statistically significant (p<0.0001) for antenatal care, health facility delivery, water treatment, latrine use, use of insecticide treated nets, presence of clinic card, and measles vaccination. Degree of improvement across the various indicators measured differed by socio-demographic contexts. The changes were greatest in the rural agrarian sites, compared to peri-urban and nomadic sites.ConclusionThe study showed that most of the components of the strategy were implemented and sustained in different socio-demographic contexts, while participatory community planning based on household information drives improvement of health indicators.

Despite focused health policies and a reform agenda Kenya has not made a breakthrough in improving the situations of households entrapped in the vicious cycle of poverty and ill health. Consequently, Great Lakes University of Kisumu developed and tested a model for facilitating improvement in the performance of the District Health System (DHS) and, hence, the health status of poor households served. The model consisted of evidence-based dialogue between the communities and service providers, working with service consumers as partners in improving service delivery and outcomes. The study was undertaken in partnership with the Ministry of Health (MOH) and the Communities. The model was tested by introducing it in selected sites and carrying out health facility and household sample surveys at the beginning of the intervention and two years later in both intervention and control sites. Among the key improvements noted were: governance and management of the health system; service delivery and health outcomes in terms of immunisation coverage; usage of insecticide treated nets; and utilisation of skilled attendance at childbirth. Based on the results, the Kenyan MOH adopted the model as a strategy for the implementation of the Kenya Essential Package for Health countrywide. The University developed the implementation guidelines and training materials for rolling out the strategy countrywide.

Parent-adolescent communication about sexual matters is one of the means that encourages adolescents to adopt responsible sexual behaviour. However, parents do not discuss sexual matters with adolescents and those who discuss to some extent; little information about sexuality is provided. This study, was, therefore aimed to find out the factors that hindered parents from communicating with their adolescent children on sexual matters. A descriptive, cross sectional study employing both quantitative and qualitative approaches was utilized. Simple random sampling was used to select households of parents/caretakers with adolescents and face to face interviews were used to collect data in February 2011. Out of 388 respondents, majority (81%) reported that they do not discuss sexual matters with the adolescents due to socio-demographic, cultural, individual and socio-environmental factors/barriers. Being male (p=0.04), parents' age over 44 years (OR< 1 at 95% CI), lower levels of education (≤primary) and income (farming and remittance) was significantly associated with "not communicating" sexual matters with the adolescents (p<0.05). These findings strengthen the need for continued sensitization of parents/caretakers to involve themselves in discussing sexual matters with the adolescents. Furthermore, guidance of parents/caretakers on how to approach the subject of sexuality and sustenance of discussions with the adolescents is paramount.

Information should form the backbone of decisions that effect change in all areas. It is therefore paramount in health, for information to be used for decision making. In effect this will bring about equity in health resource allocation. The development of comprehensive community based health information systems is increasingly becoming important for measuring and improving the quality of health services. Many developing countries including Kenya have made efforts to strengthen their national health information systems to provide information for decision-making in managing health care services. The purpose of this paper is to explore how data collected at the community level is utilised by various stakeholders within the community in order to produce actionable information for decision making. This was a descriptive, cross sectional study. The qualitative aspects of data collection involved key informant interviews and focused group discussions with the health service providers; potential health services users, and community health workers. Findings indicated that strong local ownership of data developed at the community. The main perspectives of service providers included joint ownership of health intervention programs at the community level, the community owned their health and aimed to improve it and community health workers to champion on health and development issues to bring about change.

Maternal mortality is a concern worldwide with higher disparities of 1 in 16 in developing compared to 1 in 2800 in developed countries. Kenya's maternal mortality ratio has increased from 414 per 100,000 live births in 2003 to 488 per 100,000 live births in 2009. In 2010 the figure increased to 530 per 100,000 live births. The purpose of the study was to explore the effectiveness of dialogue in improving health facility deliveries in Rachuonyo District. The main objective of the study was to explore the effectiveness of dialogue in improving health facility deliveries. A prospective longitudinal research was conducted collecting baseline and post intervention data. Data was collected using semi structured in depth interview guides based on the causes of maternal deaths. Data collection and analysis were done concurrently to help increase insights and clarify parameters under study till saturation of information. A manual for training CHWs was developed based on gaps identified from baseline data. Community health workers were trained on the community dialogue model addressing gaps identified from baseline phase. Implementation of the dialogue model was conducted by the trained community health workers at the health facility and at the community within households. Baseline findings of study included inadequate equipment and staff at the health facility, late gestation at first visit, limited knowledge on complications, expected date of delivery, frequency of antenatal care (ANC) visits and basic items collected in preparation for arrival of the baby. A post intervention evaluation was done with post natal mothers taken through dialogue to assess effectiveness of dialogue. Findings showed improved knowledge on complications, expected date of delivery, frequency of ANC visits, basic items collected in preparation for arrival of the baby and the role of the husband in relation to the care of the mother. The study concluded that inadequate staffing, supplies and equipment contribute to low uptake of skilled attendant deliveries at the health facility. Mothers had inadequate information on birth preparedness before the intervention and this improved after the intervention. The study recommended facility improvement on provision of adequate staffing, supplies and equipments. There is need for task shifting of health education role from health workers to local community health workers (CHWs) because they were overwhelmed with integration of services and unable to provide adequate birth preparedness information to mothers.