ADVERT 
ADVERTSiaya County has launched a renewed push to strengthen community health governance, emergency maternal and newborn care, referral systems and the management of essential medical commodities after a baseline assessment exposed significant weaknesses across the county’s health system.
The assessment, conducted through a partnership between Lwala Community Alliance and the County Department of Health and Sanitation, provides an evidence-based roadmap for addressing gaps that continue to affect the delivery of quality healthcare at community and facility levels.
It covered 210 of Siaya’s 221 Community Health Units (CHUs), representing 95 per cent coverage, and engaged 1,251 members of Community Health Committees (CHCs).
While the findings show that community health structures are largely established, their effectiveness remains a major concern. Only 7.6 per cent of CHCs were found to be fully functional, while 49.5 per cent were semi-functional. Another 33.3 per cent were classified as functional, with 9.5 per cent found to be non-functional.
The assessment also exposed weaknesses in community participation in health-facility governance. Only 31 per cent of CHC chairs were represented on Health Facility Management Committees, while just 22 per cent reported holding monthly review meetings.
ADVERTThe use of community health data to guide decision-making was similarly low, with only 46 per cent of committees reporting that they used available data to inform decisions. Participation in monitoring health commodities was even weaker, at just 10 per cent.
The gaps become more concerning when emergency referrals are considered. Although referral systems were reported to exist in 96 per cent of CHUs and 99 per cent had referral forms, only 30 per cent had emergency contact numbers. A mere nine per cent had functional emergency transport, while only one per cent had access to revolving referral funds.
The findings point to a system in which structures may exist on paper but lack the resources, coordination and operational capacity required to respond effectively when patients need urgent care.
A particularly serious challenge emerged in the health commodity supply chain, with 89.7 per cent of health facilities reporting stockouts.
The shortages affected several critical commodities. Stockouts of Ready-to-Use Therapeutic Food (RUTF) were reported in all assessed facilities, while shortages affected IPTAS tablets in 60.9 per cent of facilities, magnesium sulphate in 56.5 per cent, benzyl penicillin in 52.4 per cent and Depo-Provera in 48 per cent.
Beyond commodity shortages, the assessment identified weaknesses in pharmacovigilance and quality management, warehousing and storage, financial sustainability, human-resource capacity and logistics management information systems.
To address the supply-chain challenges, stakeholders are proposing activation of the commodity module within the electronic Community Health Information System (eCHIS), development of a CHU commodity dashboard and targeted training for pharmacy personnel, Community Health Assistants and Community Health Promoters on commodity management.
The interventions will also focus on strengthening procurement practices and improving monitoring of storage conditions to reduce stockouts and ensure essential medicines and supplies reach facilities when needed.
The assessment further highlighted shortcomings in Emergency Obstetric and Newborn Care (EmONC), including inadequate equipment for mentorship, knowledge gaps in neonatal and newborn care, inactive Maternal and Perinatal Death Surveillance and Response (MPDSR) committees and weaknesses in referral mechanisms.
Stakeholders are now calling for the provision of essential EmONC equipment, targeted training and mentorship, the revival and operationalization of facility-level MPDSR committees and the establishment of functional referral mechanisms capable of supporting timely emergency response.
For Siaya, the findings offer more than a diagnosis of existing problems. They provide a practical framework for directing resources and interventions towards areas where they can have the greatest impact.
Strengthening community health committees, improving emergency referral networks, securing essential commodities and increasing community participation in health governance could significantly improve accountability and service delivery.
The challenge now lies in translating the assessment into sustained action.
With the county health system already anchored on an extensive network of community health units, closing the identified gaps could strengthen the link between households, community health workers and health facilities—and ultimately improve access to timely, safe and quality healthcare for residents across Siaya County.
