Strengthening the health system capacity to monitor demographic and population health metrics through surveillance nested on existing government community health structures: A pilot from a rural area of Kenya

Document Type



Faculty of Health Sciences, East Africa


Background: The community health strategy (CHS) is a response of
the Kenyan government to reversal in gains for population health
indicators in the 1990s. CHS’s main aim is to improve health out-
comes by bridging the gap between households and the health sys-
tem. The key innovation of CHS is the development of capacity to
monitor the population and deliver primary health services at the
community level by well-trained community health workers (CHWs).
We aimed to evaluate the feasibility of generating reliable de-
mographic and household level health information using CHWs in a
rural area in Kenya.
Methods: We trained and supported 100 CHWs to conduct a
registration, enumeration and household health information data collection. They used the standard CHS household registration tool
with items covering demographic, maternal and child health, and
social determinants of disease aspects of the household. The data
were entered into a relational database and analyzed in Stata v13
(Statacorp, College Station, Houston TX, USA). We used Whipple’s
index to assess for age heaping and compared the distribution of
demographic parameter with those of other surveys in the area (e.g.
DHS) and an adjacent HDSS. Overall and category specific de-
nominators were used to evaluate the collected household health
Findings: The population of the area was 16,005 individuals living
in 2,722 households. The median (IQR) number of individuals per
household was 6 (4-7). Females comprised of 51% of the population
and 99% provided a date of birth. The median (IQR) age was 17 (8-
32) years. There was no age heaping (Whipple’s index was 97),
reflecting reasonably accurate age reporting. Children Parents/
guardians of 93% of children aged
Interpretation: This project demonstrated that it is feasible to
identify and register populations under the existing government CHS
structures as well as generate relatively accurate demographic data
which can be used as denominators in monitoring and evaluation of
population health programmes. Reporting of maternal health infor-
mation was poor and more training is needed to enable CHWs to
collect this information.




Annals of Global Health