Assessing the Enablers and Challenges on Performance of Community Health Volunteers During the Covid-19 Pandemic: a Mixed-methods Study of Machakos County

Abstract

Background: The Coronavirus disease 2019 (COVID-19) pandemic, imposed a strain on healthcare systems around the world posing significant obstacles for healthcare providers everywhere in the world. Weaker health systems which are synonymous with the developing countries were the most affected with serious impairment in health service delivery. There is, however, limited information on the enablers and challenges of community health workers’ performance during the COVID-19 pandemic. Objective: This study assessed the enablers and challenges on performance of community health volunteers in Machakos County, Kenya during the COVID-19 pandemic. Methodology: A cross sectional mixed methods survey was carried out. Data was collected from community health volunteers (CHVs) from various community health units (CHUs) in different sub-counties in Machakos County. Structured questionnaires and focused group discussion guides were used to collect data on the enablers and challenges faced by CHVs during the COVID-19 pandemic while data on the CHVs’ work output, for the period 2019 - 2021, was extracted from the Kenya Health Information System (KHIS). The data was entered and cleaned in Excel then analyzed with SPSS version 25.0. Quantitative data derived from the questionnaires and the MoH 515 was analyzed through descriptive statistics in the form of frequencies and percentages. This was summarized and presented in tables, graphs and charts. Qualitative data emanating from the FGDs and open-ended questions in the questionnaires were analyzed through thematic analysis from which conclusions were generated and findings presented verbatim. Results: The common enablers of CHVs during the COVID-19 pandemic were belonging to a social support group in their community (85.1%, n = 240) and appreciation of the CHVs efforts by their communities (99.3%, n = 280). However, the leading challenges experienced by the CHVs during the COVID-19 pandemic were inadequate or delayed stipends (100%, n = 282); concerns about contracting COVID-19 during their work (82.3%, n = 232); excessive workload (90.4%, n = 255); difficulties in transport (94.7%, n = 267) and lack of tools and materials (92.2%, n = 260). Contrary to the multiple challenges experienced by CHVs, their work output level seemingly improved as marked by an increase in the number of women aged 15 - 49 years provided with FP commodities that rose from 3,691 in 2020 to 4,212 in 2021. The number of pregnant women counseled on ANC services rose as well from 406 in 2020 to 1,742 in 2021. Conclusion: Belonging to a social support group and appreciation of CHVs efforts by the community constituted the enablers of CHVs, while lack of recognition and inadequate stipend were the leading challenges experienced by the CHVs as they had to bear the high cost of living and transport experienced during the COVID-19 pandemic. The performance of CHVs in Machakos County improved during the COVID-19 pandemic. Recommendations: Performance of community health volunteers in Machakos County remained impressive during the COVID-19 pandemic despite the challenges encountered. The county government of Machakos should make efforts to enhance the performance of CHVs in the county through providing better working conditions and reviewing their remuneration. There is a need to create more awareness on the role of CHVs in improving the health of communities.