Top

Published in:

Open Access 01-12-2021 | Climate Change | Research article

Community health volunteers challenges and preferred income generating activities for sustainability: a qualitative case study of rural Kilifi, Kenya

Authors: Adelaide M Lusambili, Njeri Nyanja, Sophie Vusha Chabeda, Marleen Temmerman, Lucy Nyaga, Jerim Obure, Anthony Ngugi

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

There is a global emphasis on engaging community health volunteers (CHVs) in low- to middle-income countries (LMICs) to reach to the vast underserved populations that live in rural areas. Retention of CHVs in most countries has however been difficult and turnover in many settings has been reported to be high with profound negative effects on continuity of community health services. In rural Kenya, high attrition among CHVs remains a concern. Understanding challenges faced by CHVs in rural settings and how to reduce attrition rates with sustainable income-generating activities (IGAs) is key to informing the implementation of contextual measures that can minimise high turnover. This paper presents findings on the challenges of volunteerism in community health and the preferred IGAs in rural Kilifi county, Kenya.

Methods

The study employed qualitative methods. We conducted 8 key informant interviews (KIIs) with a variety of stakeholders and 10 focus group discussions (FGDs) with CHVs. NVIVO software was used to organise and analyse our data thematically.

Results

Community Health Volunteers work is not remunerated and it conflicts with their economic activities, child care and other community expectations. In addition, lack of supervision, work plans and relevant training is a barrier to delivering CHVs’ work to the communities. There is a need to remunerate CHVs work as well as provide support in the form of basic training and capital on entrepreneurship to implement the identified income generating activities such as farming and events management.

Conclusions

Strategies to support the livelihoods of CHVs through context relevant income generating activities should be identified and co-developed by the ministry of health and other stakeholders in consultation with the CHVs.

Available only for authorised users

Access to Quality Care through Extending and Strengthening Health Systems.

Under the Kenya government’s Community Health Strategy, the Community Health Unit (CHU) is the lowest level of service delivery, which comprises on average 1000 households (approximately 5000 to 10,000 local population), usually within an administratively and geographically defined area and linked to a level 2 (dispensary) or 3 (health centre) healthcare facility.

Tseng YH, Griffiths F, de Kadt J, Nxumalo N, Rwafa T, Malatji H, et al. Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the south African programme. BMJ Open. 2019;9(2):e022186. https://doi.org/10.1136/bmjopen-2018-022186.CrossRefPubMedPubMedCentral

Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35(1):399–421. https://doi.org/10.1146/annurev-publhealth-032013-182354.CrossRefPubMed

Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing community health workers to address mental health disparities for underserved populations: a systematic review. Admin Pol Ment Health. 2018;45(2):195–211. https://doi.org/10.1007/s10488-017-0815-0.CrossRef

Datiko DG, Yassin MA, Theobald SJ, Blok L, Suvanand S, Creswell J, et al. Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study. BMJ Glob Health. 2017;2(4):e000390. https://doi.org/10.1136/bmjgh-2017-000390.CrossRefPubMedPubMedCentral

Glenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Tropical Med Int Health. 2011;16(9):1044–53. https://doi.org/10.1111/j.1365-3156.2011.02813.x.CrossRef

Haver J, Brieger W, Zoungrana J, Ansari N, Kagoma J. Experiences engaging community health workers to provide maternal and newborn health services: implementation of four programs. Int J Gynaecol Obstet. 2015;130(Suppl 2):S32–9. https://doi.org/10.1016/j.ijgo.2015.03.006.CrossRefPubMed

Sepulveda J, Bustreo F, Tapia R, et al. Improvement of child survival in Mexico: the diagonal approach. Lancet. 2006;368(9551):2017–27. https://doi.org/10.1016/S0140-6736(06)69569-X.CrossRefPubMed

Kok MC, Broerse JEW, Theobald S, Ormel H, Dieleman M, Taegtmeyer M. Performance of community health workers: situating their intermediary position within complex adaptive health systems. Hum Resour Health. 2017;15(1):59. https://doi.org/10.1186/s12960-017-0234-z.CrossRefPubMedPubMedCentral

Kok MC, Kane SS, Tulloch O, Ormel H, Theobald S, Dieleman M, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst. 2015;13(1):13. https://doi.org/10.1186/s12961-015-0001-3.CrossRefPubMedPubMedCentral

10.

Aseyo RE, Mumma J, Scott K, Nelima D, Davis E, Baker KK, et al. Realities and experiences of community health volunteers as agents for behaviour change: evidence from an informal urban settlement in Kisumu, Kenya. Hum Resour Health. 2018;16(1):53. https://doi.org/10.1186/s12960-018-0318-4.CrossRefPubMedPubMedCentral

11.

Brunie A, Wamala-Mucheri P, Otterness C, Akol A, Chen M, Bufumbo L, et al. Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs. Glob Health Sci Pract. 2014;2(1):103–16. https://doi.org/10.9745/GHSP-D-13-00140.CrossRefPubMedPubMedCentral

12.

Dil Y, Strachan D, Cairncross S, Korkor AS, Hill Z. Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana. J Community Health. 2012;37(6):1192–8. https://doi.org/10.1007/s10900-012-9569-5.CrossRefPubMed

13.

Glenton C, Colvin CJ, Carlsen B, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10:CD010414. https://doi.org/10.1002/14651858.CD010414.pub2.CrossRef

14.

Ormel H, Kok M, Kane S, Ahmed R, Chikaphupha K, Rashid SF, et al. Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health. 2019;17(1):59. https://doi.org/10.1186/s12960-019-0387-z.CrossRefPubMedPubMedCentral

15.

Chuma J, Okungu V. Viewing the Kenyan health system through an equity lens: implications for universal coverage. Int J Equity Health. 2011;10:22. https://doi.org/10.1186/1475-9276-10-22.CrossRefPubMedPubMedCentral

16.

Kenya Community Health Policy 2020. https://www.health.go.ke/wp-content/uploads/2020/07/Kenya-Community-Health-Policy-Signed.pdf. Retrieved 29 May 2021.

17.

Ngugi AK, Nyaga LW, Lakhani A, Agoi F, Hanselman M, Lugogo G, et al. Prevalence, incidence and predictors of volunteer community health worker attrition in Kwale County, Kenya. BMJ Glob Health. 2018;3(4):e000750. https://doi.org/10.1136/bmjgh-2018-000750.CrossRefPubMedPubMedCentral

18.

Lusambili AM, Naanyu V, Wade TJ, Mossman L, Mantel M, Pell R, et al. Deliver on your own: disrespectful maternity care in rural Kenya. PLoS One. 2020;15(1):e0214836. https://doi.org/10.1371/journal.pone.0214836.CrossRefPubMedPubMedCentral

19.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042.CrossRefPubMed

Title: Community health volunteers challenges and preferred income generating activities for sustainability: a qualitative case study of rural Kilifi, Kenya
Authors: Adelaide M Lusambili
Njeri Nyanja
Sophie Vusha Chabeda
Marleen Temmerman
Lucy Nyaga
Jerim Obure
Anthony Ngugi
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Climate Change
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06693-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Community health volunteers challenges and preferred income generating activities for sustainability: a qualitative case study of rural Kilifi, Kenya

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program

Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions

Optimising the integration of technology-enabled solutions to enhance primary mental health care: a service mapping study

Accessing and utilising gender-affirming healthcare in England and Wales: trans and non-binary people’s accounts of navigating gender identity clinics

Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents