Health Systems Strengthening (HSS) Programme

Health Systems Strengthening (HSS)

Our Purpose

We believe that health is a basic human right. Everything we do ensures lasting health change for all.


The Challenge

Strengthening health systems is critical towards the attainment of the Sustainable Development Goals. Health care systems in low and middle-income countries have evolved over the years but still, struggle to be resilient and manage emerging health concerns.

Despite the relatively recent shift of health care systems towards a more people-centred approach, health programmes, policies, and interventions rely on traditional thought processes. For years, the focus of the health care system has been on the treatment of disease rather than the support of a complete state of physical, mental, and social well-being for individuals and communities as outlined in the Alma-Ata Declaration. As a result, the solutions crafted to improve health outcomes have often fallen short of the desired result. Solutions developed without the consideration for the circumstances in which people, learn, work, and the communities they live in, do not allow for sustained action. This not only results in poor health outcomes, but also results in inefficiency, inequity, and non-responsive health systems. This phenomenon is not unique to Kenya, and evidence shows that globally, over 40% of health care spending is wasted.

The global health workforce is unevenly and inequitably distributed. The World Health Organisation (WHO) Americas region, with 10% of the global disease, has 37% of the world’s health workforce. In contrast, the African region, with 24% of the global disease burden, only has 3%.

Kenya’s health system faces a huge human resource for health shortage similar to other African countries. The country faces severe shortages of critical cadres, is unable to attract and retain health workers, frequent health workforce strikes due to poor working conditions, inadequate or lack of essentials tools, medical and non-medical supplies, poor distribution and low skill mix that lead to diminished productivity and a demotivated health workforce.

Additionally, policies and health system design has been crafted without the incorporation of community inputs; communities they are meant to serve. In Africa, almost 45% of people rate their level of autonomy in health care decisions as poor.

Although there is some level of infrastructure improvement and increased range of laboratory services in middle and low-income countries, implementation of national laboratory quality standards remains suboptimal. Quality laboratory services have not been disseminated to the primary health care settings (level 2, 3 and all level 4). Departmental approaches have left out other departments and health care worker cadres in support of sustainable laboratory systems strengthening.

Inadequate coordination at national and regional or county level among stakeholders creates a lot of wastage and duplication, which further worsens the limited available human resources for health. Inadequate institutionalisation of laboratory standards and quality controls and as well as accreditation services with over-reliance on external donor sources and inadequate coordination of the partners at National and county level to manage the limited resources and advance sustainable capacity development and implementation of a reliable laboratory management systems remains underutilised.

Despite the importance of focusing on community-based interventions meant to serve communities more effectively and efficiently, Kenya has lagged in supporting the growth of community systems that have been proven effective and evidenced to improve health outcomes. A concrete example of how the health and community systems have had effective integration is through Community Health Workers. Community Health Workers have been supporting individuals and communities to take charge of their health and well-being alongside community-based organisations. While they play an important role in both community and national health systems, Community Health Workers are still overlooked and not remunerated in the majority of the 47 counties. In cases where they do receive funding for service delivery, it is likely linked to donor-funded projects rather than as part of the main health system.

The consideration of how social determinants of health influence health outcomes are well outlined through programmatic and academic research. Addressing these concerns requires the view that communities are not only the beneficiaries of a strong, comprehensive and a people-centred health care system, but reaffirms the fact that they are at the core of its design success.


The Opportunity

At the helm of creating lasting health change for all, are the communities we serve.

Kenya’s Vision 2030, Constitution of 2010 and the Kenya Health Policy (2012 – 2030) speak to transforming Kenya into a globally competitive and prosperous country with a high quality of life by 2030. As Kenya continues on the journey towards Universal Health Coverage, a strong primary health care infrastructure that incorporates community health will be critical.

There exist opportunities to promote Public-Private Partnerships for health financing and establishing mechanisms for mutual benefits for better human resources for health to provide quality health service delivery. There is also a need to strengthen devolution and identify HRH gaps while working with partners and stakeholders to fill the skills mix needs for both entry and in-service levels and service provision gaps. Advocacy for amicable resolving of HRH strife and minimising frequent strikes, the recognition and remuneration of Community Health Workers continue to be essential in strengthening health systems.

Integration of laboratory systems with the larger health systems quality standards and leadership in providing the evidence needed to win and succeed in the institutionalisation of quality across the whole health system presents another opportunity. Laboratory and sample networking aligned to existing capacities are critical to providing timely feedback for patient care and management, as is country-led coordination of lab strengthening activities. There is an opportunity for the Ministry of Health and County Health Systems to leverage existing and donor resources to ensure ownership, sustainable financing and resilience, including emergency surveillance. There is also an opportunity to make use of and adopt appropriate interoperable technology that will provide timely reporting, monitoring and evaluation of laboratory systems for evidence-driven decision making. Laboratory accreditation processes will act as key drivers for the dissemination of laboratory standards at the primary health care level and establish mentorship programmes to achieve standardisation of quality laboratory services, thus promoting patient safety.  

Our Theory of Change

At Amref Health Africa in Kenya, we understand and embrace the central role that communities play in sustainable and effective people-centred health systems. We strengthen health systems by focusing on collaborating with communities to build sustainable solutions, as they are uniquely placed to frame any solution in a manner that truly reflects their unique challenges. We build on our years of experience working alongside communities through the support of our partners, to advocate for social change, building the capacity of communities and community-based organisations, and engaging in policy change that facilitates meaningful community engagement.

We are contributing to the strengthening of HRH planning, human resource information management, regulatory and professional bodies, and pre-service and in-service training. Amref Health Africa in Kenya continues to support the formulation of health policies and guidelines that support the Ministry of Health and County Governments to effectively plan and provide quality health services to address local needs and challenges. To achieve the lasting health change we desire, our community systems strengthening approach focuses on the use of technology to build the capacity of CHWs.

Amref is contributing to building more resilient and responsive health systems by working with health workers to deliver quality patient-focused services. We also support a primary health care strategy for service delivery that reorients the model of care. This model strives to bring services closer to communities and endeavours to provide timely, efficient, accessible and effective services. Our collaboration with communities extends to our work with both National and County Governments in the development and implementation of policies that speak to these ideals. An example of this collaboration is highlighted through our legislative engagement advocating for the recognition, remuneration and enactment of policies that put CHWs in the mainstream health system to support reverse referrals and awareness creation through a holistic approach to community health needs.

We believe that HRH challenges can be closed through multi-sector (public-private partnership mix) approaches including advocating for meaningful engagement of HRH and stakeholders to adequately identify and manage causes of strikes, capacity building, adequate remuneration and motivation of HRH to deliver quality health services effectively.

We are strengthening the laboratory health systems through capacity building, partnerships, mentorship and monitoring using a robust technological approach that supports the accreditation of laboratories and extension health facilities to offer quality services within a strengthened health system led by the national and county governments in collaboration with private and public sector players.

Our Ask

We seek funding, shared value partnerships and collaboration from public and private sector partners to effectively implement evidence-based and sustainable HRH initiatives to attract and retain the best HRH skill mix to provide quality health services, to build laboratory systems that are robust, efficient and effective to meet the needs of the community and to effectively implement a health system-wide approach that provides for seamless, sustainable, resilient health systems with reliable quality health information to make informed health system decisions and to work with communities to improve access to effective and comprehensive care.

We are also looking to engage with partners interested in supporting local innovation that yields sustainable health system and community health solutions.