Predictors of community health workers retention in service in Makueni County, Kenya
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Date
2014-07-24
Authors
Kithuka, Peter Munyao
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Abstract
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.
Description
A thesis submitted in fulfilment of the requirements for the award of the Degree of Doctor of Philosophy in Public Health (Health Systems Management) of the School of Public Health of Kenyatta University
November, 2016