title: Community-based health care in Kibwezi, Kenya: 10 years in retrospect.
abstract: In response to the interest of the Kenya government in community-based health care, the Kibwezi Rural Health Scheme was developed by the African Medical and Research Foundation (AMREF) in a semi-arid district in eastern Kenya. Based on a community co-operative philosophy and focussing on health promotion and prevention, the scheme includes the following: a health centre with a 15-bed in-patient unit including four maternity beds, out-patient services, and a 15-bed nutrition rehabilitation unit; a cadre of volunteer community health workers, trained by AMREF, who form the backbone of the project; maternal child health/family planning and nutrition services including an applied nutrition programme, a water project; and a mobile health unit. Designed as a replicable model health programme, the intention was that services would be gradually taken over by the Ministry of Health of Kenya. Much has been learned in the development of the project which should be meaningful to others considering similar endeavours. One of the first lessons learned was that the time taken to sensitize the community to community-based health care is critical to the success of the project and may need to be as long as 1-2 years. Another was that gaining the support of the community for the community health workers (CHW) requires a considerable effort on the part of project staff, but seems to be the only viable solution to the remuneration and recognition of the CHW's work. It also became apparent that preventive and promotive health services should be integrated structurally and operationally with curative health services to provide the most benefits for the community served. Finally, although there are some differences of opinion, it is felt that with some refinements, the project could be replicated in other parts of Kenya.
authors.affiliation: African Medical and Research Foundation, Nairobi, Kenya.
authors.forename: K E
authors.initials: KE
authors.lastname: Johnson
authors.forename: W K
authors.initials: WK
authors.lastname: Kisubi
authors.forename: J K
authors.initials: JK
authors.lastname: Mbugua
authors.forename: D
authors.initials: D
authors.lastname: Lackey
authors.forename: P
authors.initials: P
authors.lastname: Stanfield
authors.forename: B
authors.initials: B
authors.lastname: Osuga
mesh_terms: D002662:Child Health Services / Q000458:organization & administration; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education; D005193:Family Planning Services; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000458:organization & administration; D009313:National Health Programs / Q000458:organization & administration*; D009747:Nutritional Physiological Phenomena; D000078329:Workforce