Influence Of Community Health Volunteers Empowerment On Implementation Of Community Health Projects: A Case Of Mukuru Slum, Nairobi County, Kenya

Abstract

Community health worker (CHW) programs are implemented in many low and middle income countries to increase access to quality care for underserved populations. Despite the importance of CHW as frontline workers in healthcare provision, evaluations of CHW programs show that these health workers often lack the necessary equipment and motivation to implement the community health projects. This study examined the influence of community health workers on implementation of community health project in Mukuru Slum, Nairobi County, Kenya. The specific objectives were to determine the influence of training, motivation, availability of health facilities and the moderating effect of resource mobilization on implementation of community health projects. Kanter‟s theory of empowerment, Maslow hierarchy of needs theory and resource mobilization theories were used to inform the study. Mukuru has nine villages; Mukuru kwa Reuben, Mukuru kwa Njenga, Sinai, Paradise, Jamaica, Kingstone, Mariguini, Fuata Nyayo and Kayaba. The study adopted a descriptive research design. The target population of the study was one thousand five hundred (1,500) - trained CHWs in Mukuru community slum. Yamane (1967) formula was utilized to obtain a sample size of 362 respondents. Stratified random sampling technique was employed select the sample. The study utilized both the questionnaires and interview guide, as the main data collection methods. SPSS software was used to generate the descriptive statistics and inferential statistics. Factor analysis was conducted to assess the convergent validity of the hypothetical constructs. The hypothesis on training, motivation, availability of health facilities and implementation of community health projects were adopted as they had values greater than 0.5. Correlation results indicated that training of community health workers, motivation of community health workers, availability of health facilities, resource mobilization and implementation of community health projects were positively and significantly related. Regression results indicated that training, motivation, availability of health facilities and implementation were positively and significantly related. In addition, the joint effect of training, motivation, availability of health facilities had a positive and significant effect on implementation of community health projects. The findings indicated that interaction in terms of training and resource mobilization, motivation and resource mobilization, health facilities and resource mobilization had a positive and significant effect on implementation of community health projects. The study concluded that the community health volunteers in Mukuru Slum Community receive regular training on new methods and techniques to implement health projects and they are required to conduct health services with professionalism regardless of the social status of the community. In addition, the community health volunteers occasionally receive some allowances from the community health facilitators (informal recognition) and there is no promotion of community health workers that promotes career development. However, there is moderate provision of remote diagnostics and medical kits that enhance service delivery and adequate transport when required to attend to emergency situations in the community. Under resource mobilization, there was no adequate funding from the relevant government entities that facilitates health service delivery. The study recommends that training of CHVs should be re-designed and delivered in phases covering more content. The study further recommends on harmonization of incentives to increase commitment through income for their families. Motivation through compensation, career development and work flexibility should be regularly revised for the implementation of the health projects. Lastly, there should be regular replenishment of supplies, medicines, and equipment since when the health facilities run out of supplies, the patients are not able to afford from the chemist and private facilities.