Primary Health Care Act

Section 1. Short Title Section This Act may be cited as the Primary Health Care Act, 2023.

Section 2. Interpretation Section In this Act— "Cabinet Secretary" means the Cabinet Secretary responsible for matters relating to health; "care coordination" means a proactive approach that brings professionals and providers together to address the needs of service users to ensure they receive integrated and person-centered care across various settings; "county executive committee member" means the county executive committee member responsible for matters relating to health; "community" means a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time; "community health committee" means the functional structure overseeing the operations of a community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") ; "community health officer" means a trained health professional who is assigned to supervise the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters under their community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") ; "community health care services" means the services specified under section 5 ; "community health promoter" means a member of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") who is selected and appointed in accordance with section 9 of this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under section 22 (3) of this Act and is trained to provide community health services to defined households; "community health unit" means a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health service delivery; "health care professional" has the same meaning assigned to it under section 2 of the Health Act ( No. 21 of 2017 ); "health care provider" has the meaning assigned to it under section 2 of the Health Act ( No. 21 of 2017 ); "health facility" has the same meaning assigned to it under section 2 of the Health Act ( No. 21 of 2017 ); "hospital" includes health facilities at levels four, five and six respectively; "household" means a social unit which shares the same socio-economic needs associated with consumption and production; "primary health care" means essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") at every stage of their development, through their full participation and at an affordable cost to the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") and country, in the spirit of self-reliance and self-determination; "primary health care workforce" includes health care providers and community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; "Primary Health Care Network" means an administrative health region comprising of a hub ("a primary health care referral facility which should be a level four facility;") and spokes ("level three and two health facilities and the community health units;") established to deliver access to primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services for patients, as well as to coordinate with other hospitals in order to improve the overall operational efficiency of the network; "hub" means a primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") referral facility which should be a level four facility; "spokes" means level three and two health facilities and the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health units; "multi-disciplinary team" means a team of health care professionals with diverse expertise and skills who jointly assess, plan and manage health care that matches patients’ needs and those of the catchment population to improve health outcomes; "Universal Health Coverage" means that all individuals and communities receive the health services they need including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care without suffering financial hardship; and "vulnerable groups" means vulnerable groups as defined under Article 21 of the Constitution.

Section 3. Objects Section promote and fulfill the rights of all persons in Kenya towards the progressive realization of their right to the highest attainable standards of health care;

Section 4. Primary health care services Section 4(1) Primary health care services shall be accessed at the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") or at a health facility in accordance with this Act and any other written law. Section 4(2) The services referred to in subsection (1) shall include health promotion, prevention, curative, rehabilitation and palliative services.

Section 5. Community health care services Section 5(1) Community health care services commence at the household ("a social unit which shares the same socio-economic needs associated with consumption and production;") . Section 5(2)(a) health education and promotion; Section 5(2)(b) disease prevention and control to reduce morbidity, disability and mortality; Section 5(2)(c) family health services in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 5(2)(d) environmental health and hygiene in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 5(2)(e) provision of first aid for treatment of minor illnesses and injuries; Section 5(2)(f) community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") -based surveillance; Section 5(2)(g) psychosocial support, rehabilitation, and palliative care in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 5(2)(h) referrals; and Section 5(2)(i) management of health data in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") .

Section 6. Facility health care services Section 6(1) Facility health care services commence at the health facilities. Section 6(2)(a) promotive; Section 6(2)(b) preventive; Section 6(2)(c) curative; Section 6(2)(d) rehabilitative; and Section 6(2)(e) palliative.

Section 7. Delivery of primary health services Section adopting supportive and innovative modem approaches for disease identification, monitoring, surveillance, early warning, research, community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") education and information sharing;

Section 10. Public participation in the selection ofcommunityhealth promoters Section 10(1)(a) publish and publicize, through the mechanisms established by a county government under section 95(1) of the County Governments Act ( No. 17 of 2012 ), a notice of the proposed selection process, at least seven days before the conduct of the process; Section 10(1)(b) agenda with respect to the selection process and any other issue connected to the selection process; Section 10(1)(b)(i) agenda with respect to the selection process and any other issue connected to the selection process; Section 10(1)(b)(ii) criteria for selection as a community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; Section 10(1)(b)(iii) the process of submitting their nomination for selection; and Section 10(1)(b)(iv) such other information as the committee member may consider necessary for the effective participation and conduct of the selection process; Section 10(1)(c) ensure that the information circulated under paragraph (b) is provided in format that is simple to understand and is also available in the prevailing local language; Section 10(1)(d) take measures to ensure the participation of all persons required to participate in the process including persons with disabilities and marginalized communities within the county; Section 10(1)(e) provide, where necessary, interpretation services for persons who are not conversant with the national language, where the national language is the principle language of communication during the conduct of the public participation forum; Section 10(1)(f) keep and maintain an attendance register of all persons attending the selection process; Section 10(1)(g) ensure that all persons attending the public participation forum signify their attendance by signing the attendance register; Section 10(1)(h) keep a record of the minutes of the selection process; and Section 10(1)(i) publicise the decision regarding the persons selected during the public participation forum through the mechanism established under section 95(1) of the County Governments Act ( No. 17 of 2012 ). Section 10(2)(a) principles of citizen participation in counties under section 87 of the County Governments Act (No. 17 of 2012); Section 10(2)(b) provision of effective mechanisms for the involvement of the public including special interest groups who would be affected by or be interested in a decision; Section 10(2)(c) participants’ equitable access to the information they need to participate in a meaningful manner; Section 10(2)(d) establishment of an appropriate feedback mechanism; Section 10(2)(e) adherence to the national values under Article 10 of the Constitution; Section 10(2)(f) adherence to the principles of public participation as may be prescribed by any written law; and Section 10(2)(g) ensuring that the needs and interests of all persons participating in the process are taken into account. Section 10(3)(a) the quorum required for the holding of the public participation which shall not be less than seventy adult residents within the respective county; Section 10(3)(b) the keeping of records prepared with respect to a public participation forum conducted under this Act; Section 10(3)(c) the process of the conduct of the selection process including the voting, decision making, quorum and recording of information with respect to the process; and Section 10(3)(d) such other guidelines as may be necessary for the effective conduct of the public participation forum.

Section 11. Functions ofcommunityhealth promoters Section 11(1) A community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") shall assign to each community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") households in such localities in such a manner as shall be prescribed by the county for the purpose of facilitating access to and ensuring the effective delivery of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health services at the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") . Section 11(2)(a) sensitize the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") on the importance of healthy lifestyles and of quality health services; Section 11(2)(b) provide community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") disease surveillance by reporting early signs of imminent health disasters or emergencies; Section 11(2)(c) enroll and monitor the health status of members of the households assigned to the community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; Section 11(2)(d) keep and maintain a record of members in all households assigned to the community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; Section 11(2)(e) monitor the rehabilitation and integration of persons who require such services in the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 11(2)(f) appropriate sanitation and hygiene techniques including household ("a social unit which shares the same socio-economic needs associated with consumption and production;") water treatment; Section 11(2)(f)(i) appropriate sanitation and hygiene techniques including household ("a social unit which shares the same socio-economic needs associated with consumption and production;") water treatment; Section 11(2)(f)(ii) good nutrition; Section 11(2)(f)(iii) maternal and postnatal care including advice on breastfeeding, immunization, child health care and family planning; Section 11(2)(f)(iv) the prevention, transmission and management of communicable diseases; and Section 11(2)(f)(v) the prevention and management of non-communicable diseases; Section 11(2)(g) render first aid services to an assigned household ("a social unit which shares the same socio-economic needs associated with consumption and production;") and where necessary, make referrals to the link facility; Section 11(2)(h) monitor the growth of children under the age of five years in an assigned household ("a social unit which shares the same socio-economic needs associated with consumption and production;") ; Section 11(2)(i) provide support to the assigned household ("a social unit which shares the same socio-economic needs associated with consumption and production;") on quality family-based care and support for a patient; Section 11(2)(j) submit reports, at such intervals as shall be determined by the county director of health, on the health of each member of an assigned household ("a social unit which shares the same socio-economic needs associated with consumption and production;") and the barriers to health and health care in the household ("a social unit which shares the same socio-economic needs associated with consumption and production;") to the community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") ; Section 11(2)(k) collect information on the health status of the assigned households; Section 11(2)(l) report incidence of side effects of drugs; and Section 11(2)(m) perform such function as may be assigned by the county executive committee member ("the county executive committee member responsible for matters relating to health;") in county legislation or under any other law. Section 11(3)(a) be ethical; Section 11(3)(b) inform the household ("a social unit which shares the same socio-economic needs associated with consumption and production;") of the use to which the information shall be put; Section 11(3)(c) ensure confidentiality; Section 11(3)(d) ensure accuracy of the information captured; and Section 11(3)(e) transmit the information within the timelines specified by the county director of health.

Section 12. Register ofcommunityhealth promoters Section 12(1) Each county director of health shall keep and Register of maintain a register of all community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters working in the county. Section 12(2) The county director of health may designate a community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") within the county public service a registrar to keep and maintain the register under subsection (1). Section 12(3)(a) name and identification details; and Section 12(3)(a)(i) name and identification details; and Section 12(3)(a)(ii) contact details; Section 12(3)(b) information on the link facility to which the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters report; Section 12(3)(c) the training database for the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters; Section 12(3)(d) the households assigned to each community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; Section 12(3)(e) all community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters who have been de-registered; and Section 12(3)(f) such other information as the county government shall prescribe. Section 12(4) There shall be kept and maintained, by the community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") responsible for overseeing the delivery of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health services in each community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") , an extract of the register under subsection (1) with respect to the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters deployed to households in the respective community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") . Section 12(5) A community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") shall notify the community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") in the respective community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") of any changes to their particulars and the information shared with the registrar under subsection (2) within fourteen days of such change. Section 12(6)(a) verify the information; and Section 12(6)(b) update the change of particulars in the register.

Section 13. Retention ofcommunityhealth promoters Section training at least once a year;

Section 8. Primary health care workforce Section 8(1)(a) community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters appointed in accordance with this Act; and Section 8(1)(b) health care providers. Section 8(2) Each county government shall take all necessary measures to build the capacity of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters for the proper and efficient implementation of this Act.

Section 9. Recruitment ofcommunityhealth promoters Section 9(1) A community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") shall be selected by the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") through a public participation forum and appointed by the county government. Section 9(2)(a) is a citizen of Kenya; Section 9(2)(b) is above the age of 18 and is of sound mind; Section 9(2)(c) is a responsible and respected member of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 9(2)(d) understands the role of a community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") ; Section 9(2)(e) is a resident of the respective community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") for a continuous period of not less than five years prior to the appointment date; Section 9(2)(f) is literate and can read and write in at least one of the national languages and the local language; and Section 9(2)(g) is not disqualified for appointment to office by the above criteria of by any other law. Section 9(3) A community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") shall be appointed on such terms and conditions as the respective county public service board shall determine. Section 9(4) Each county executive committee member ("the county executive committee member responsible for matters relating to health;") shall prescribe, in the county legislation and regulations approved by the respective county assembly for the conduct of the public participation forum under subsection (1).

Section 14. Role of the ministry responsible for health. Section 14(1)(a) formulate, develop and disseminate primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") policies, guidelines and other relevant frameworks; Section 14(1)(b) in consultation with the county governments, provide standards and guidelines to ensure equitable primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") service delivery; Section 14(1)(c) consolidate and analyze national primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") data from the respective county primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") advisory committee and ensure its timely transmission to stakeholders for use in decision making and resource allocation; Section 14(1)(d) facilitate knowledge sharing and dissemination of best practices in the provision of primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services; and Section 14(1)(e) provide capacity development for the effective management of primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") across the Republic of Kenya. Section 14(2) The National Government shall appropriate and transfer to the county revenue fund of respective county governments such monies as shall be required for the effective performance of their functions under this Act.

Section 15. Financing ofprimary health carefunctions Section 15(1) The National Government may, in accordance with the law relating to county governments additional allocations, provide such resources as may be necessary for the effective performance of the functions of county governments under this Act. Section 15(2) The additional resources allocated under sub-section (1) shall be a supplement, and not a substitute, to the resources allocated by the respective county government in respect to the delivery of primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services in counties.

Section 16. Role of county governments Section oversee the implementation of the national policies, guidelines and standards on primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services;

Section 17. Countyprimary health careadvisory committee Section 17(1) Each county government shall establish a county primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") advisory committee. Section 17(2)(a) the county executive committee member ("the county executive committee member responsible for matters relating to health;") responsible for health, who shall be the chairperson; Section 17(2)(b) a representative from the county department responsible for environment; Section 17(2)(c) a representative from the county department responsible for social protection; Section 17(2)(d) a representative from the county department responsible for education; Section 17(2)(e) a representative from the county department responsible for finance and planning; Section 17(2)(f) a representative from the county department responsible for the county public service board; Section 17(2)(g) a representative from the county department responsible for water and sanitation; Section 17(2)(h) a representative from the county department responsible for roads; Section 17(2)(i) a representative from the county department responsible for agriculture; Section 17(2)(j) the county commissioner or their representative designated in writing; and Section 17(2)(k) the county director of health who shall be the secretary to the committee. Section 17(2) The committee members in subsection (1) shall be appointed in writing by the county executive committee member ("the county executive committee member responsible for matters relating to health;") and shall serve for a period of three years. Section 17(3)(a) monitor and evaluate the implementation of primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") ; Section 17(3)(b) identify and advocate for key primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") issues with the respective county health departments; Section 17(3)(c) receive, work constructively and address applicable community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") issues, care coordination ("a proactive approach that brings professionals and providers together to address the needs of service users to ensure they receive integrated and person-centered care across various settings;") and develop innovative ideas for service delivery; Section 17(3)(d) promote communication between the health department, other stakeholders and the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 17(3)(e) provide beneficiary input on departmental activities, policies, plans and projects at the individual, program, organization and system levels in the county; Section 17(3)(f) propose further opportunities for community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") engagement that will promote primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") improvements in the county; Section 17(3)(g) provide advice and input into primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") issues; Section 17(3)(h) carry out advocacy and resource mobilization; Section 17(3)(i) fairly represent the views of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 17(3)(j) gather the views of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") they represent through their primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") networks; Section 17(3)(k) provide feedback after meetings to members of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; and Section 17(3)(l) provide leadership and advice in relation to the beneficiary and community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") views on primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") and primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network service delivery, planning and development in the relevant county.

Section 18. Primary health care networks Section 18(1) Each county executive committee member ("the county executive committee member responsible for matters relating to health;") shall, subject to subsections (2) and (3) and by notice in the Gazette , establish a primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network at the sub county level. Section 18(2) A primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network shall serve a catchment population as shall be determined by the county primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") advisory committee. Section 18(3) A primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network shall comprise of a hub ("a primary health care referral facility which should be a level four facility;") and spokes ("level three and two health facilities and the community health units;") . Section 18(4) A primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network shall facilitate delivery and access to primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services from the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") , as well as coordinate with health facilities in order to improve the overall operational efficiency of the network. Section 18(5) Every person shall be registered as a member of a primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network.

Section 19. Primary health care network committee Section 19(1)(a) five representatives of the sub-county health management team, nominated by the county executive committee member ("the county executive committee member responsible for matters relating to health;") ; Section 19(1)(b) a representative of the faith based health providers; Section 19(1)(c) a representative of the private sector providers; Section 19(1)(d) a representative from a community health committee ("the functional structure overseeing the operations of a community health unit;") ; Section 19(1)(e) a representative of development partners; and Section 19(1)(f) the sub-county commissioner. Section 19(2) The members of the committee shall, in the first meeting, elect a chairperson from amongst themselves. Section 19(3) The committee members in subsection (1) shall be appointed in writing by the county executive committee member ("the county executive committee member responsible for matters relating to health;") and shall serve for a period of three years. Section 19(4)(a) coordinate the implementation of programmes for optimal functioning of the primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network; Section 19(4)(b) support the primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network to set targets in line with agreed county targets and local health needs; Section 19(4)(c) lead prioritization of service package or range of services to be offered through the primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network; Section 19(4)(d) ensure equitable distribution of resources and health services within the primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network; Section 19(4)(e) reference and implement human resource management plans to ensure availability and equitable distribution of health care workers and community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters as per level of care; Section 19(4)(f) support supervision and coordination of mentorship and training activities by the multi disciplinary teams; Section 19(4)(g) consolidate and analyze the Health Management Information System data including community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health for completeness and validity from the primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") network to make timely decisions at the sub-county level; and Section 19(4)(h) mainstream and facilitate integration of services to optimize on available resources and avoid duplications.

Section 20. Community Health Units Section 20(1) Each county government shall establish and operationalize community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health units. Section 20(2) A community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") shall serve a catchment population of up to five thousand persons in accordance with national guidelines. Section 20(3) A community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") shall comprise of approximately one thousand households in accordance with national guidelines. Section 20(4) A community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") shall, under the coordination of a community health committee ("the functional structure overseeing the operations of a community health unit;") , be linked to a health care facility to facilitate delivery and access to primary health care ("essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination;") services for the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") .

Section 21. Community Health Committee Section 21(1)(a) a representative of faith based organizations; Section 21(1)(b) a representative of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 21(1)(c) a representative of vulnerable groups ("vulnerable groups as defined under Article 21 of the Constitution") ; Section 21(1)(d) a representative of the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters; Section 21(1)(e) any other co-opted member as per community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health needs; and Section 21(1)(f) the community health officer ("a trained health professional who is assigned to supervise the community health promoters under their community health unit;") , who shall be the secretary. Section 21(2) The members of the committee shall, in the first meeting, elect a chairperson from amongst themselves. Section 21(3) The committee members in subsection (1) shall be appointed in writing by the county executive committee member ("the county executive committee member responsible for matters relating to health;") and shall serve for a period of three years, renewable once. Section 21(4)(a) provide leadership in the implementation of health and other related community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") services; Section 21(4)(b) coordinate the selection of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters within the community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") in a public participation forum; Section 21(4)(c) prepare and present the community health unit ("a group of households not exceeding one thousand within a defined geographical area and formally recognized as level one in the health system for community health service delivery;") annual work-plans and operational plans to the link facility health committee; Section 21(4)(d) plan, coordinate and conduct community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") dialogue and health action days; Section 21(4)(e) work with the link facility to promote facility accountability to the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 21(4)(f) hold quarterly consultative meetings with the link facility; Section 21(4)(g) create an enabling environment for implementation of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health services; and Section 21(4)(h) mobilize resource for sustainability.

Section 22. Transitional provisions Section 22(1) All rights and obligations, however arising, of the national and county government and subsisting before the effective date shall continue as rights and obligations of the national and county governments as assigned under this Act. Section 22(2) All personnel appointed by the county public service boards and serving under each county government in respect of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health services shall be deemed to be in the service of the county government on the effective date. Section 22(3) Despite section 9 , a person appointed as a community health volunteer or community health worker at the commencement of this Act shall be deemed to be appointed as a community health promoter under this Act.

Section 23. Offences and penalties Section 23(1)(a) conduct any procedure that is beyond their training and approved scope of work; Section 23(1)(b) administer to a person medication that is not authorized by clinical standards and guidelines under this Act or any other applicable law; Section 23(1)(c) conduct deliveries for pregnant women; Section 23(1)(d) negligently handle property entrusted to them; Section 23(1)(e) use tools, gadgets or properties under their custody for purposes other than the delivery of community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health services authorized under this Act and any other applicable law; Section 23(1)(f) solicit financial or other rewards for personal gain whether or not in recognition of effort in delivering services to the community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") ; Section 23(1)(g) withdraw services as community ("a specific group of people, usually living in a defined geographical area, who share common values and norms, and are arranged in a social structure according to relationships which the community has collectively developed over a period of time;") health promoters without giving notice of intention to do so, except in a case of emergency; Section 23(1)(h) falsify any records or data collected by them in course of duty; Section 23(1)(i) engage in political or any other activities that may conflict with their duty; and Section 23(1)(j) disclose the client’s health information to unauthorized person. Section 23(2) Any community health promoter ("a member of the community who is selected and appointed in accordance withof this Act or a community health volunteer or a community health worker who is deemed to be a community health promoter under(3) of this Act and is trained to provide community health services to defined households;") who contravenes the provisions of this section shall be subject to disciplinary actions as prescribed by law.

Section 24. Adherence to data protection Section Every person shall, in the implementation of this Act, adhere to the provisions of the Data Protection Act ( No. 24 of 2019 ), in the collection, processing and transmission of personal data.

Section 25. Regulations Section The Cabinet Secretary ("the Cabinet Secretary responsible for matters relating to health;") shall, in consultation with county governments, make regulations generally for the better carrying out of the provisions of this Act.