BackgroundThe shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio-demographic contexts, based type of tasks shifted. The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them.MethodsThis was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies.ResultsThe study found that there were tasks to be shifted and motivation strategies that were common to all three contexts. Common tasks were promotive, preventive, and simple curative services. Common motivation strategies were supportive supervision, means of identification, equitable allocation of resources, training, compensation, recognition, and evidence based community dialogue.Further, in the nomadic and peri-urban sites, community health workers had assumed curative services beyond the range provided for in the Kenyan task shifting policy. This was explained to be influenced by lack of access to care due to distance to health facilities, population movement, and scarcity of health providers in the nomadic setting and the harsh economic realities in peri-urban set up. Therefore, their motivation strategies included training on curative skills, technical support, and resources for curative care. Data collection was viewed as an important task in the rural site, but was not recognized as priority in nomadic and peri-urban sites, where they sought monetary compensation for data collection.ConclusionsThe study concluded that inclusion of curative tasks for community health workers, particularly in nomadic contexts, is inevitable but raises the need for accreditation of their training and regulation of their tasks.
A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question “What is the reliability of data collected at the Community level by Community health workers?”. The methods which we use to find an reliable answer to this question is “Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability”. Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and action...
Mobile health (mHealth) programs offer opportunities to improve the sexual and reproductive health (SRH) of adolescents by providing information. This paper reports the findings of a study carried out in Homabay County, Kenya, to assess stakeholders’ perspectives on access to and use of mobile phones by adolescents for SRH education. We aimed to establish whether mobile phones could facilitate access to SRH information by adolescents and the barriers to be addressed. This was a qualitative exploratory study involving adolescents, parents, teachers, health care workers, and community health volunteers. Data were collected through focus group discussions (FGDs) and key informant interviews (KIIs), and were analyzed through thematic and content analysis. Respondents lauded mHealth as an effective and efficient approach to adolescent SRH education with a potential to promote the learning of useful SRH information to influence their behavior formation. Respondents pointed out bottlenecks such as the limited ownership of and inequitable access to phones among adolescents, logistical barriers such as lack of electricity, internet connectivity, and the impact of phones on school performance, which must be addressed. The usefulness of mHealth in adolescent SRH education can be enhanced through inclusive program formulation and co-creation, implemented through safe spaces where adolescents would access information in groups, and supported by trained counselors.
Introduction maternal and neonatal health status indicators have steadily improved over time in Kenya. Significant challenges remain, including persistent inequities between population subgroups, and a health system that delivers variable quality care and inconsistent access to care. This paper highlights results of an ex-post evaluation to assess the impact of maternal and health systems strengthening intervention to improve newborn health outcomes in Bungoma County, Kenya, focusing on access to and quality of maternal and neonatal care. Methods the study design was quasi-experimental, using household surveys to assess outcomes at baseline and end-line. Stratified cluster sampling was used to identify households, based on heath facility catchment areas. Inclusion criteria were women aged 18-49. Chi-square and fisher´s exact tests were used. Patched-up design was used to compare outcomes before and after the intervention and intervention and control sub-counties. Results provision of transport vouchers decreased barriers to accessto health care, resulting in an increased number of deliveries in health facilities. Women in the end-line group were 95% more likely to deliver at a health facility compared to 74% at baseline. The intervention improved potential and effective access to antenatal care as well as deliveries in health facilities. This positively impacted quality of care provision in the sub-counties. Conclusion key elements of health system strengthening included reducing cost barriers and enhancing the capacity of the health facilities to deliver high quality care. The intervention addressed commonly identified supply-and demand-side barriers, providing stronger evidence that addressing these hindrances would improve utilization of maternal and child health services.
CitationOchieng BM, Duma S, Ochieng JN, Kaseje DCO. Development and testing a volunteer screening tool for assessing community health volunteers' motives at recruitment and placement in Western Kenya. Psychol Cogn Sci Open J. 2016; 3(1): 6-16. doi: 10.17140/PCSOJ-3-119 Copyright ©2016 Ochieng BM. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In times of inadequate resources and rising public demand, social service organizations rely on volunteers to meet needs. In the current human resource for health crisis in Africa there is urgent need for community health volunteers (CHVs). Studies have highlighted problems of high attrition rates leading to high replacement training costs among CHVs. There is need for careful selection of volunteers that can serve long-term, once trained. This study was done to develop a volunteer assessment framework for recruitment of CHVs. The framework is based on identification intrinsic motives for volunteering that have been shown to be associated with long volunteer service. Methods: The assessment tool was developed by searching literature for theory based constructs and assessment items associated with volunteering. These constructs and items were synthesized into a proposed assessment framework. The framework was subjected to face content and construct validation in West Kenyan context in phase 1 of the study. The validated framework was tested for ability to differentiate between long serving volunteers and nonvolunteers matched by gender, age and residence. The 2 groups were presented with test items and asked to record their agreement on a scale of 1 to 5 on the reasons why people volunteer. Results: From literature we identified functional, role identity, and social exchange as theories underpinning volunteering. From these theories we identified 8 constructs to include in a proposed volunteer assessment framework. We tested the framework and although all the eight constructs satisfied internal consistency test only 5: altruism, materialism, social adjustment, esteem enhancement and career development were statistically significantly more associated with either volunteers or non-volunteers. Therefore, only these were included on the final volunteer assessment framework, for identification of long serving volunteers in the local context. Conclusion: We propose a volunteer assessment tool with the 5 constructs and 25 assessment items for identification and recruitment of CHVs, with motives consistent with long-term volunteer service. The final framework consists of altruistic (altruism, social adjustment, esteem enhancement) or egoistic (material gain and career development) constructs with 25 assessment statements. The frame work would able to identify individuals with altruistic motives to include and those with egoistic tendencies to exclude during a volunteer recruitment exe...
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