Predictors of community health workers retention in service in Makueni County, Kenya
Kithuka, Peter Munyao
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Globally, the reported attrition rates of Community Health Workers (CHWs) vary between 3.2% and 77% with high rates being associated with volunteer CHWs. In Kenya, retention rate is estimated at 67% while in Makueni it varies between 50% and 98%. The success of community programmes is often hampered by low retention rates which affects the sustainability of interventions and increases training costs, since it needs continuous replacement which makes the programme difficult to manage. The main objective of this study was to establish predictors of community health workers retention in service in Makueni County. The study used a crosssectional study design employing mixed methods of data collection incorporating researcher-administered questionnaires, Focus Group Discussions and Key Informant Interviews. The study population consisted of 2,800 CHWs commissioned by the Ministry of Health in Makueni County. Sample size of the study was 603 CHWs selected through Cluster sampling. 552 CHWs participated in the study. Purposive sampling was used to select participants for Focus Group Discussions and Key Informant Interviews. Quantitative data was subjected to descriptive, cross-tabulation and logistic regression analysis using SPSS version 20 software. Thematic analysis was done using Nvivo to gain an in-depth understanding of the study results and triangulate quantitative findings. Results showed that of the 552 CHWs interviewed, 87.7% were married, 78.2% were aged between 30-49 years, 68.1% were females, 59.6% had completed secondary level of education, 97.6% were Christians, 62% were subsistence farmers and 64% were residents in lowland zone. The retention rate among the study participants was 69.4%. Logistic regression results showed that the predictors of retention of CHWs in Makueni County included; financial incentives (p=0.000, OR= 129.477), provision of health updates (p=0.000, OR=4.489), belonging to a self-help group (p= 0.004, OR=2.555), provision of reporting tools (p=0.000. OR=0.022 and provision of essential medical kits (p=0.000, OR=4.768). In conclusion, there is need to review community health strategy implementation guidelines to harmonize provision of regular financial incentives, essential medical kits, reporting tools and health updates (through more comprehensive training programmes, refresher trainings and regular dissemination and sharing of new health information). The national and county government and partners of the community health strategy should also create effective mechanisms for livelihood support of CHWs such as establishing self-help groups as a sustainability measure for the community health strategy.