Factors influencing the performance of community health workers in Nandi hills sub-county

Abstract

The 2006 World Health Organization report recognized shortages of professional health workers as one of the key ingredients in the growing crisis of providing health services, particularly in low income countries. In Kenya, CHWs workforce was adopted as a component of cost effective strategies in addressing the health care needs of underserved communities. The implementation of the CHWs concept in Kenya is marked by unanswered questions of long term sustainability and program effectiveness. Despite the vast experience with CHWs the burden of disease continues to increase in magnitude and diversity and relatively little scientific evidence is available to answer basic questions notably the determinants influencing the performance of CHW. However both the performance of CHWs as change agents and the feasibility of implementing and sustaining large-scale CHW programs have been called into question. The purpose of this study was to investigate the factors influencing performance of CHWs in Nandi Hills sub-county. The objectives of the study were to assess the influence of social-cultural, health system practice and policy, environmental and economic factors on the performance of CHWs in Nandi-Hills subcounty. A descriptive research design was used. Both quantitative and qualitative data collection methods were used. Systematic sampling method was used to identify the respondents. Quantitative data was collected from 87 community health workers of which 81 responded to the questionnaires, while qualitative data was collected from community health management team (CHMT), clients (households) and community health extension workers (CHEWs). Data was presented using tables while inferential statistics were computed using regression and correlation. Findings showed that performance of CHWs was low (50-74%). There was strong correlation between socio-cultural factors (0.884**) and performance of community health workers. The findings also show that there is a strong correlation (0.799**) between health system factors and performance of CHWs. Further, the findings show that there is strong correlation (0.777**) between economic factors and performance of community health workers. Finally, the findings show that there is a strong correlation (0.775**) between environmental factors and performance of community health workers. There should be improved staffing of the facilities where community units are linked in order to strengthen referrals and linkage systems especially taking into consideration the spatial distribution and population density. This will improve support supervision from CHEWs to CHWs during their community work.