FACTORS INFLUENCING PERFORMANCE OF COMMUNITY HEALTH WORKERS AS PROVIDERS OF BASIC HEALTH CARE IN GANZE SUB-COUNTY, KILIFI COUNTY-KENYA

Abstract

The global scarcity of competent, motivated health workers is widely recognized as a significant obstacle to strengthening health systems and advancing Universal Health Coverage (UHC). Community Health Workers (CHWs) play an essential role in making UHC a success. Since 2006, CHWs have been identified as level one health caregivers as stipulated in the Kenya national health strategic plan. However, little is known about the performance of the CHWs under the realm of community health strategy. The objective of this study was to describe factors influencing the performance of community health workers as providers of essential health care services Ganze Sub-County, Kilifi. The study was conducted across the four wards in the Sub-County targeting all the community health workers in the 12 community units. A descriptive cross-sectional study design was adopted, and a random sampling technique was used to recruit respondents from the study population. The study recruited 162 CHWs for quantitative data, 40 CHWs for four focused group discussions (FGDs), and 12 key informant interviews (KIIs) were conducted among community health extension workers, ward public health officers, and nurses at link facilities. Trained research enumerators assisted in the administration of questionnaires to obtain data from the individual CHWs. The collected data were entered into Microsoft Excel (Version 2013) database and then exported to R (version 3.6.3) for analysis. Descriptive analysis was done, and a chi-square test was used to test the association at 95% confidence intervals of each variable associated with CHW performance. CHW's performance was classified as high or low. All data were reported as proportions stratified by performance level. Approximately half 88 (54%) of the CHWs were aged 30 to 39 years, while only 26 (16%) were <30 years old. One hundred and forty-eight (91%) were marriedwhile 96 (59%) were satisfied, 45 (28%) were relatively satisfied, and 12 (7.4%) were delighted with doing the CHW work. Based on the performance indicators, 67/162 (41%; 95%CI xiii 34 to 49%) and 95/162 (59%; 95%CI 51 to 66%) were categorized as high and low performance, respectively. The significant constraints faced by CHWs were: financial constraints 129 , 30 (19%) had secondary and above education, and 134 (83%) reported monthly income KSHs <5000. Only 9 (5.6%) said to be unsatisfied with their work , (80%), lack of transport 109 (67%), and lack of community support 50 (31%). In the multivariable analysis, secondary education and above (aRR 0.52 (95%CI 0.27−0.98)), missing a CHWs meeting (aRR 0.66 (95%CI 0.48−0.90)) and somewhat/very satisfied CHWs (aRR 0.59 (95%CI 0.43−0.81)) were significantly associated with lower risk of low performance. While attending community nutrition training (aRR 2.72 (95%CI 1.36−5.42)), receiving any support to facilitate their work (aRR 1.67 (95%CI 1.05−2.68)) and community appreciation of CHWs by thanking them after service (aRR 1.90 (95%CI 1.05−3.42)) were associated with a higher risk of low performance; thus the performance of CHWs was poor at 41%. Overall from the thematic analysis and triangulation of FGD notes, CHWs Incentives, health system, and community support are needed to improve the performance of CHWs.