Discussion paper; No. 002/2010 - Efficacy of Community Based Health Care in Kenya - An Evaluation of AMREF's 30 Years.

Abstract

AMRH has been involved in health development in Kibwezi, Eastern Kenya, since 1978. Its interventions have evolved in tandem with changes in community health needs and changes in government priorities. They have also greatly deepened and expanded in coverage in the 30 years of working in, for and with this hard-to-reach community. The paper is an evaluative research aimed at establishing the achievements of this longterm engagement. It presents the historical evolution of interventions, assesses AMREF's programmes in relation to national health policy. In addition, it analyses the success of the various interventions in terms of project objectives, implementation processes. expected outputs and outcomes, achievements of partnerships and sustainability and identifies programme challenges and lessons learned. Using both secondary and primary data, the paper utilises a combination of methods to assess the efficacy. effectiveness and sustainability of AMREF"s inventory. The paper concludes that, although it is difficult to precisely measure the proportion of AMREF's contribution. successful achievement of intended outputs a11d measurable or imputed health outcomes confirms a definite positive contribution to the improvemer1t in the health status of the commu11ity. In addition. the interventions have had positive results in terms of health systems strengthening. The paper presents project·specitic achievements, identifies intervention programming challenges. and demonstrates that the approach adopted has produced useful le~sons for improving the health status of communities through strengthening of health systems. The key lessons which emerge are that community participation and the use of community resources and institutions as entry points. understanding the community context and creating trust. and prior design of an exit strategy are necessary conditions for the success and sustainability of community-focused interventions.