Factors influencing implementation of community health strategy by community health workers in Nyeri County, Kenya
Kabue, Margaret N
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A large population of Kenyan continues to carry one of the highest preventable burdens of ill health in the world (MOH, 2007). A health population is integral in the overall development of a country and thus cannot be ignored. To deliver this health package to Level 1 (community), the Community Health Strategy (CHS) was introduced. The Community Health Strategy which was launched in 2006 and its implementation started in 2007, aimed at reaching to 16 million Kenyans (3.2million households) in 5 years. Four years in its implementation, the targets are far from being met. In the case of Nyeri County, only 36 Community Units (CUs) are established against a target of 139 and only 10 out of the 36 CUs are active. Based on this information, this study sought to assess the factors influencing implementation of CHS by Community Health Workers (CHWs) in Nyeri County of Kenya. The objectives of the study were; to assess the extent to which workload of CHWs influence implementing Community Health Strategy, to explore the extent to which training of CHWs influence implementation of Community Health Strategy, to establish the extent to which of availability of CHW's Tool Kits influence implementation of Community Health Strategy and to establish the extent to which incentives to CHWs influence Community Health Strategy. A survey research design was used in this study. A sample size of 60 (53 CHWs and 7 Community Health Extension Workers) was picked and to whom the questionnaire was administered. The questionnaire was piloted in the neighboring Kiambu County to CHWs implementing Community Health Strategy resulting to a coefficient reliability of 0.7. The data collected was organized and analyzed by use of Statistical Package of Social Scientist which generated frequencies and percentages of the study findings. The results from the study indicated that workload to the CHW s, their training and availability of tool kits have a significant influence of implementation of Community Health Strategy. The study also established there is a significant overload on CHWs with 17 (32.1%) having more than 20 households assigned, 10 (18.9 %) of CHWs are able to visit all the households assigned and 19 (35.8) % not able to attend monthly meetings. Most CHWs 41 (77.4%) felt inadequate based on training while 40 (75.5%) felt inadequate based on lack of CHW Tool Kits. According to this study incentives to CHWs do not have much influence on implementation of Community Health Strategy; with most CHWs 43 (79%) indicating that they were getting incentives derived from willingness to offer services to their community. This study recommends an extension of the implementation of the Community Health Strategy period, a review on the workload and training curriculum of the CHW, to allow equitable assignment of households based on the diverse prevailing conditions where these CHWs work and provision and harmonization of reporting tools for CHW s It also recommends provision of tool kits and reporting tools to CHWs as well as simplification of the reporting tools to make them user-friendly. This study did not delve into the quality of the work done by CHWs, an area that could give more information if researched on.