Performance among community health workers in Wajiru District, Nairobi County, Kenya

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Margaret, Mulingwa W.
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The 2006 World Health Organization report recognized shortages of professional health workers as one of the key ingredients in the growing crisis of providing health services, particularly in low income countries (Mumbo et al., 2013). In mitigation the Alma-Ata declaration of 1978 promoted wider use of Community Health workers to provide selected interventions and promote health behaviours at the community level. In Kenya, CHWs workforce was adopted into the NHSSP II, 2010-12 as a component of cost effective strategies in addressing the health care needs of underserved communities. MOPHS and implementing partners have therefore been implementing the Community Strategy (CS) for effective delivery of level 1 health services to the community as part of the Kenya essential package for health since 2006. However both the performance of CHWs as change agents and the feasibility of implementing and sustaining large-scale CHW programs have been called into question.The study aimed at describing the determinants influencing performance of CHWs in Njiru district through a descriptive cross-sectional survey.Both quantitative and qualitative data collection methods were used. Systematic sampling method was used to identify the respondents. Quantitative data was collected from 225 CHWs while qualitative data was collected from DHMT Members,public health officers and CHEWs. Data was presented using tables, graphs and cross tabulation while inferential statistics were computed using chi square and odds ratio. Thematic analysis was done on qualitative data. Findings showed that performance of CHWs was low (34.7%). Gender was statistically significant in relation to the CHW performance (χ2=7.619, df=1, p=0.006) and CHWs who earned between Ksh3501-4500 were associated with non-performance (Unadjusted OR:4.775, 95% CI 1.038-21 P<0.045). The period of community strategy training (χ2=6.502, df=2, p=0.039),application of feedback information (χ2=12.429, df=3, p=0.006) significantly affected CHWs performance. Communication (P<0.001) was statistically significant with performance increasing with number of barazas held. Male respondents were 96% less likely to be associated with performance compared with female CHWs (AOR 0.968, 95% CI 0.114-1.822).CHWs who attended training for one week and three weeks respectively were two times more likely to be non performers as CHWs in the delivery of level one health services (AOR 2.21, 95% CI 0.030-4.384, P=0.047) and (AOR 2.49, 95% CI 0.174-4.804, P=0.035) than respondents who attended training for four weeks and more. The use of feedback information was statistically significant and when adjusted for no feedback report, the odds of using the feedback information report to address gaps was highly associated with performance (AOR -1.099, 95%CI -1.997- 0.201, P<0.016). From this study the performances of community health workers in Njiru district Kenya in the delivery of level one health service was below average. Various demographic, health systems and community factors are central in the Performance of CHWs in the delivery of level one services. From this study the implementation and realization of the key CHS targets in Peri- urban setting is challenging therefore stakeholders need to develop a clear contextualized CHWs guideline tailored for Peri- urban settings. The findings from this study will be useful to policy makers, programme officers and communities in focusing interventions aimed at improving community strategy and programs, ultimately improving community high health impacts indicators.
Master of Public Health in the School of Public Health 111p.June, 2014