“It’s like these CHCs don’t exist, are they featured anywhere?”: Social network analysis of community health committees in a rural and urban setting in Kenya

Abstract

Background In Kenya, Community Health Committees (CHC) were established to enhance community participation in health services. Their role is to provide leadership, oversight in delivery of community health services, promote social accountability and mobilize resources for community health. CHCs form social networks with other actors, with whom they exchange health information for decision-making and accountability. This case study aimed to explore the structure of a rural and an urban CHC network and to analyze how health-related information flowed in these networks. Understanding the pathways of information in community settings may provide recommendations for strategies to improve the role and functioning of CHCs. Methods In 2017, we conducted 4 focus group discussions with 27 community discussants and 10 semi-structured interviews with health professionals in a rural area and an urban slum. Using social network analysis, we determined the structure of their social networks and how health related information flowed in these networks. Results Both CHCs were composed of respected persons nominated by their communities. Each social network had 12 actors that represented both community and government institutions. CHCs were not central actors in the exchange of health-related information. Health workers, community health volunteers and local Chiefs in the urban slum often passed information between the different groups of actors, while CHCs hardly did this. Therefore, CHCs had little control over the flow of health-related information. Although CHC members were respected persons who served in multiple roles within their communities, this did not enhance their centrality. It emerged that CHCs were often left out in the flow of health-related information and decision-making, which led to demotivation. Community health volunteers were more involved by other actors such as health managers and non-governmental organizations as a conduit for health-related information. Conclusion Social network analysis demonstrated how CHCs played a peripheral role in the flow of health-related information. Their perception of being left out of the information flow led to demotivation, which hampered their ability to facilitate community participation in community health services; hence challenging effective participation through CHCs.

How context influences the functionality of community‐level health governance structures: A case study of community health committees in Kenya

“…One notable finding in a Kenyan study was that though CHCs were composed of elite community members, they were not central in the flow of health‐related information within their social networks. Contrary to expectations, CHCs were shown to operate in the periphery of their networks and could not influence decision‐making since they did not have access to information 38 …”

“…35 There is literature on facility-based HFMCs in Kenya, 22,36,37 but literature on community health structures for overseeing community health services in limited. 38 This research aimed to contribute to the body of knowledge on community participation by examining how contextual factors influence the functionality of CHCs in diverse ecological settings in Kenya.…”

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

“…These structures are generally weak and often have functionality problems such as lack of community participation, biased member selection, and weak relationships with the health system [ 89 ]. A study in Kenya found that CHCs were disconnected from other actors in the health sector and that they hardly played a role in CHW support and community participation [ 90 ]. A study in India found that village health and sanitation committees (VHSCs) performed few of their specified functions for decentralized planning and actions, and concluded that they need education, mobilization, and monitoring [ 91 ].…”

Health system responsiveness: a systematic evidence mapping review of the global literature

“…ethnographic, narrative and document analysis) [154][155][156][157], and offer insights relating to the operational processes and configuration of how these mechanisms function best, including specific activities such as training/meeting approaches and composition; implementation challenges or enablers [128,135,156,[158][159][160]; the roles of various systems actors in the functioning of these mechanisms, and the nature of relationships and networks (e.g. between state and non-state actors), as well as issues relating to leadership, representation, power dynamics, trust and communication [128,159,[161][162][163][164][165]. It is also emphasized across this literature that mechanisms operate in a specific context, and their functioning cannot be separated from their context [162,166].…”