Determinants of Coping Strategies Adopted by Community Health Workers Engaged in Organisations Supporting Vulnerable Children in Kakamega County, Kenya

Abstract

Community Health Workers (CHWs) bolster health workers and improve the living standards for vulnerable populations especially the vulnerable children (VC). However high attrition rates among CHWs resulting from the challenges they faced, have been reported in many health programs and this has slowed down the achievement of Sustainable Development Goal (SDG)-3. The purpose of this study was to analyze the determinants of the adopted coping strategies by CHWs engaged in organizations that supporting VC in Kakamega. The study objectives were; To establish the socio-demographic characteristics of CHWs engaged in Organizations supporting VC in Kakamega County; To assess the resources available to CHWs engaged in Organizations supporting VC in Kakamega County; To establish CHWs’ perception on their work situation when engaged in Organizations supporting VC in Kakamega County; To investigate the challenges faced by CHWs engaged in Organizations supporting VC in Kakamega County; To establish the coping strategies adopted by CHWs engaged in Organizations supporting VC in Kakamega County; To determine the influence of selected factors (socio-demographic characteristics, resources, perceptions and challenges) on the coping strategies adopted by CHWs engaged in organizations supporting VC in Kakamega County. A crossectional survey design was used to describe the opinions of a proportionate sample of 191CHWs from different Faith/Community Based Organizations. Six program coordinators of Catholic Relief Services Mwendo (CRSM) purposively sampled were also included in the study. Pretested interview schedules and KI guides were used for data collection. Cronbach coefficient Alpha was used to assess internal consistencies of items in the tools. Data was analyzed using range, frequencies, Chi-square and Spearman correlation coefficient. Qualitative data was analyzed by content and thematic analysis. The findings revealed a 93.2% response rate with a majority of the participants being female, married, Christians, with at least secondary education. They were in their 40s in terms of age in years and had worked for at least 5 years. More than half of them had low proficiency levels in their skills and had average self-esteem. Organizational and community resources were adequate to them hence they had a positive perception of their situation, in spite of challenges of high workload, stock outs of tools and materials and inadequate funds that they faced. Consequently 59% of them used negative coping strategies like emotion focused and avoidance. Age (p=0.027), period of service (p=0.029), organizational resources (p=0.004), belonging to Social support groups (p=0.024), getting community support (p=0.021) and challenges like high workload (p=0.022) and inadequate funds (p=0.008) influenced their coping strategies. Hence, it was recommended that guiding and counseling centers to be established by the organizations, for CHW’s with challenges to get relevant help. CHWs who were over 50 years should be given more support to cope positively with their work situation. National governments and donors should strongly invest in integrated CHW programs to enable equitable, efficient and effective use of the existing funding. Policy makers and program implementers should develop budgetary support to facilitate transport of CHWs to their clients and also develop strategies to ensure the standardized workload per CHW is adhered to. Advocacy is needed at the County government level, to promote financial investment in Community Health and integrated service delivery.