Chapter 2: Carry out community health promoters and CHC training

Community health promoters (CHPs) and Community Health Committees (CHCs) play a critical role in delivering primary health care services and mobilizing communities towards improved health outcomes in Kenya. Effective training of CHPs and CHCs ensures they possess the necessary knowledge, skills, and motivation to perform their duties efficiently. This chapter focuses on the systematic planning and preparation required to conduct successful training sessions for CHPs and CHCs, addressing both foundational and technical aspects tailored to community health contexts.

2.1 Planning Training of CHPs

Planning the training of community health promoters (CHPs) means deciding what they must learn, in what order and how, so that they can do the work the community health unit expects of them. Training is planned around the health priorities of the community and the starting knowledge of the trainees. Community health services in Kenya are delivered through the county health system, so the plan also follows national guidance and the needs reported by the facility that supports the unit. A well-planned training builds the ability of CHPs to give health education, report health events, refer sick people and provide basic care. The content falls into two groups: basic training, which every CHP needs, and technical training, which builds on it with specific health interventions. Delivery of the training itself, the training materials and the needs assessment are covered in their own topics of this chapter.

2.1.1 Basic

Basic training gives every CHP the knowledge and skills that the role rests on. It is designed for new CHPs and for those with little health background, and it focuses on skills needed in every household visit and community meeting, whatever the disease or programme.

Core health knowledge

A CHP needs a simple understanding of how the body works and how common illnesses such as malaria, diarrhoea and respiratory infections show themselves. This knowledge is not meant to make the CHP a clinician. It lets the CHP recognise danger signs early and refer the person to a health facility at the right time.

Ethical conduct and confidentiality

CHPs are taught to respect privacy, to keep what they learn about a household to themselves except where the health team needs it for care, and to treat every person with respect regardless of age, sex, religion, disability or health status. This protects people's rights and keeps the community's trust, without which health work cannot continue.

2.1.1.1 Communication

Communication training prepares the CHP to give health messages, listen to households and build trust. It covers active listening, which means giving the speaker full attention and checking that you understood; respectful dialogue; the use of simple words in the language of the community; and messages that respect local culture. It also covers body language, such as eye contact, a calm voice and an open posture, and how to use pictures and demonstrations. Training methods include role plays of a household visit, practice sessions with a fellow trainee and feedback from the trainer.

Example: a trainee practises explaining to a caregiver why a baby should receive only breast milk for the first six months, then the trainer and fellow trainees comment on the words and the manner used.

2.1.1.2 Leadership

Leadership training prepares CHPs to guide, motivate and work with others in the community health unit and its Community Health Committee (CHC). It covers working in a team, setting an example in health behaviour, making decisions, settling disagreements calmly, sharing out tasks, and being accountable for time and resources. It also covers how to work with community leaders, elders and groups so that health activities have their support. Case scenarios and group tasks are useful methods, because leadership is learnt by practising it.

Example: trainees are given a scenario in which two CHPs disagree about who covers a household, and they discuss how a leader would settle it fairly.

2.1.1.3 Community health and development

This module explains how health and development depend on each other. Illness reduces a family's ability to farm, trade and send children to learn, while poverty, poor water, poor housing and low education increase the risk of illness. Trainees learn that health is shaped by these wider conditions and that communities can act on them together. The module introduces community participation, which means that the community takes part in identifying problems, planning actions and carrying them out, and the principles of primary health care that go with it, such as fair access, working with other sectors and using simple, acceptable methods.

CHPs also learn community mobilisation techniques: how to organise community meetings, how to identify local health problems with the community and how to encourage collective action. They learn to understand the social structure of villages and settlements so that actions are acceptable and can be sustained.

Example: a community that finds many children miss days of learning because of diarrhoea may decide to build latrines and a handwashing point together, a development action that also improves health.

2.1.1.4 Resource Mobilization

Resource mobilisation is the work of finding and organising the people, materials, money, time and skills needed for health activities. A community health unit seldom has everything it needs, so CHPs are trained to identify what is available locally and what must be sought from partners. The module covers the types of resources, the possible sources, how to make a simple request, and how to account for what is received.

• Community resources: Labour, local materials, a venue, volunteers and contributions from households.
• Local leaders and groups: Support from elders, village groups and local business people.
• Government support: Supplies and technical support through the health facility and the county health system.
• Partners: Non-governmental organisations and other agencies working in the area.
• Accountability: Receipts, records and feedback to the CHC and the community show that resources were used for the stated purpose, which keeps donors and the community willing to give again.

Example: for a child weighing day, the community provides a shaded venue and volunteers, while the health facility lends weighing scales and tally sheets.

2.1.1.5 Report Writing

Report writing training teaches CHPs to record what they see and do and to pass it on in a clear, short form. Reports are the way the health facility and the community health committee learn what is happening in the unit, so that planning, supply of commodities and disease surveillance are based on facts. CHPs learn to use simple tools such as registers and checklists, to write down information as it happens and to send it to the facility on time.

A simple report states the date, the place, the activity, who took part, what was done, what was found, the challenges and what is recommended. Accuracy, honesty and confidentiality are stressed, and the information collected is used for health work only.

Example: after a household visit round, a CHP records the number of households visited, the number of children referred and the reason, and gives the summary to the community health assistant.

2.1.1.6 Financial Management

Financial management training prepares CHPs and committee members to handle small amounts of money and goods honestly. It covers making a simple budget for an activity, recording every receipt and payment, keeping money safely, and reporting openly to the committee. The purpose is to protect the unit from loss and suspicion.

• Budgeting: List the activity, the items needed and the expected cost before spending.
• Record keeping: Write every amount received or paid in a cash book, with a receipt or a signed voucher for each payment.
• Safe custody: Keep money and goods in a secure place under the control of authorised people.
• Reporting: Give the committee a regular statement of income, spending and balance.
• Avoiding misuse: Keep personal and unit money separate and never pay out without approval.

Example of a simple cash book: opening balance Ksh 5,000, plus receipts Ksh 2,000, less payments Ksh 1,500. Closing balance = 5,000 + 2,000 − 1,500 = Ksh 5,500.

2.1.2 Technical

Technical training builds on the basic training by teaching specific health interventions and the tools used to deliver them. It is needed by CHPs who take part in programmes such as nutrition, immunisation, maternal and child health, HIV and malaria control. The detailed health messages for each of these areas are taught in the topic on obtaining health messages in Kenya Essential Packages for Health; the training plan decides which of them each CHP will learn.

Maternal, newborn and child health skills

This module covers the basics of care in pregnancy, danger signs during pregnancy and after birth, newborn care, immunisation schedules and child growth monitoring. CHPs learn to support mothers with breastfeeding advice and to refer women and children with danger signs without delay.

Use of health technologies and tools

CHPs are trained to use simple tools correctly, such as rapid diagnostic tests where their role allows, weighing scales, the mid-upper arm circumference tape and mobile phone applications for reporting. Correct use helps accuracy and saves time.

Emergency preparedness and first aid

CHPs learn to manage minor injuries, give basic first aid and respond to emergencies such as accidents or outbreaks until a health worker takes over. This is especially important where professional care is far away.

Monitoring and evaluation techniques

CHPs learn to check how their work is going, using simple indicators, household surveys and group discussions. The results show what is working and what must change.

2.1.2.1 Nutrition

Nutrition training equips the CHP to promote good feeding and to find children and mothers at risk of malnutrition. It covers the main food groups and how to make a balanced meal from local foods, feeding in pregnancy and while breastfeeding, and infant and young child feeding. The CHP learns that a baby is given only breast milk for the first six months, that other foods are added from six months while breastfeeding continues, and that older children need a varied diet.

CHPs also learn to measure growth, to screen children with a mid-upper arm circumference tape and to recognise swelling of both feet, and to refer any child with signs of severe malnutrition to the health facility. They learn to counsel caregivers kindly, using the foods available in the household.

2.1.2.2 WASH

WASH stands for water, sanitation and hygiene. Training prepares the CHP to promote safe water, proper sanitation and good hygiene practices that prevent diseases such as diarrhoea, cholera and typhoid.

• Water: Safe sources, treating drinking water by boiling, filtering or using chlorine, and storing it in a clean covered container.
• Sanitation: The use and care of toilets and latrines, safe disposal of waste, and community approaches that lead households to build and use latrines.
• Hygiene: Handwashing with soap and water after using the toilet, after cleaning a child, before preparing food, before eating and before feeding a child.
• Practical demonstration: CHPs learn to demonstrate handwashing and to make a simple handwashing point from local materials.

2.1.2.3 HIV

HIV training prepares the CHP to give accurate information, support testing and care and reduce stigma. It covers how HIV is passed on, which is through unprotected sex, from mother to child during pregnancy, birth or breastfeeding, and through blood contact such as shared needles; and how it is not passed on, which is through ordinary contact such as shaking hands, sharing food or using the same latrine.

CHPs learn the value of confidential, voluntary testing and counselling, the role of condoms and other prevention methods, and how to link people to care. They learn how to encourage people who are on treatment to take it every day as prescribed, to trace people who stop attending, and to reduce stigma in the community. A CHP does not make a clinical diagnosis or start treatment. Where trained and authorised the CHP supports testing, and in every case informs, encourages, refers and follows up.

2.1.2.4 Malaria

Malaria training prepares the CHP to promote prevention and early treatment. Malaria is caused by a parasite passed on by the bite of an infected female Anopheles mosquito. CHPs learn to recognise fever, chills, headache and body aches, and to send anyone with fever for a test at the health facility, or to test them where the CHP has been trained and authorised to do so.

• Prevention: Sleeping under a treated mosquito net every night, draining stagnant water and clearing bushes around homes, and making sure that indoor spraying where it is offered is accepted by households.
• Groups needing special attention: Pregnant women and children under five are at greater risk of severe disease and are advised to seek care quickly.
• Danger signs: Convulsions, unusual sleepiness, repeated vomiting, inability to drink and difficulty breathing mean urgent referral.
• Treatment: Antimalarial treatment is given according to national guidelines after a positive test, and the CHP supports the patient to finish the full course.

Chapter Summary

This chapter focused on the comprehensive process of carrying out training for Community Health Promoters (CHPs) and Community Health Committees (CHCs). It began with planning the training, covering essential basic skills such as communication, leadership, community health and development, resource mobilization, report writing, and financial management, alongside technical topics including nutrition, WASH, HIV, and malaria. The preparation for training needs was emphasized to ensure relevance and effectiveness. Gathering appropriate training materials like manuals, stationery, flip charts, projectors, and computers was highlighted as crucial for a successful training session. The chapter then detailed the steps involved in conducting training for CHPs, ensuring knowledge transfer and skill development. It further addressed the importance of relaying updates to keep community health workers informed. Lastly, the chapter explored how to obtain health messages from the Kenya Essential Packages for Health, focusing on areas such as nutrition, immunization, food safety and hygiene, family planning, HIV and STIs, deworming, and WASH, forming a solid foundation for community health promotion activities.