Factors Influencing Performance of Community Health Workers in Primary Healthcare Service Provision in Mbita District, Homabay County

Abstract

The use of community members to render certain basic health services to their communities is a concept that has existed for at least five decades however, existing literature on factors influencing performance of Community Health Workers (CHWs) and their determinants are scanty and greatly overlooked. The purpose of this study was to determine factors influencing performance of community health workers in primary health care service provision in Mbita District, Homa-Bay County. Using descriptive study design, the researcher employed purposive and stratified sampling techniques where 43 respondents were included into the study to represent CHW's, CHEW's and DHMT. Data was collected using structured and semi-structured questionnaires and analyzed using SPSS version 20 for windows. Testing of hypotheses was done using Kruskal Wallis test.The study revealed a significant relationship between intrinsic motivation and CHW performance (pvalue= O.009}.Those who agreed (mean rank=19.4) contributed greatly to this difference. In addition,the CHW's who are intrinsically motivated are approximately 4 times (OR=3.9) likely to perform better than those who are not. Contra wise, there was no significant relationship between health workers training and CHW performance (p-value=0.346). However, majority of the CHW's (n=28, mean rank=15.8) ranked the trainings as effective. Interestingly, majority of those who receive training (n=18, mean rank=17.2) rated the trainings as inadequate and suggested three or more trainings in a year were necessary (73 %( n=22}}.There was a significant relationship between support supervision and CHW's performance (p-value=O.002}.Those who agreed (mean rank=18.4) contributed greatly to this difference. Moreover, the CHW's who received supportive supervision are 1 times (OR=1.1) more likely to perform better.As expected, there was a significant relationship between community support and CHW's performance (p-value=O.013}.Those who rated the level of community support as high (mean rank=17.8) contributed greatly to this difference however, the community support is inadequate (80.8%}.Furthermore, the CHW's who receive community support are approximately 4 times (OR=3.8) likely to perform better than those who do not.Besides, no significant relationship exist between CHW performance and health worker selection (p-value=O.187). However, majority of the CHW's were nominated by the community (70% (n=21) and were 17 times (OR=16.7) able to perform. The researcher strongly recommends that government needs to develop working plans, policies and strategies to sensitize and involve the communities in-addition to improving trainings on primary healthcare.This could be looked into collaboratively by both the government and other health partners in ensuring horizontal implementation of health policy and consequently, help the community health workers yield a more significant health impact demonstrated by effectiveness in performance in Mbita District, Homa- Bay County