Abstract
BackgroundA significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare coverage, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area in Kenya.MethodsThis study adopted an exploratory qualitative approach. Using a semi-structured questionnaire, we conducted 10 Focus Group Discussions with the CHVs and 10 Key Informant Interviews with County and Sub-county Ministry of Health and Ministry of Agriculture officials including multi-lateral stakeholders’ representatives from two sub-counties in the area. Data were audio-recorded and transcribed verbatim and transcripts analysed in NVivo. Researcher triangulation supported the first round of analysis. Findings were mapped and interpreted using a theory-driven analysis based on the six-step Ultra-Poverty Graduation Model.ResultsWe mapped the UPG Model’s six steps onto the results of our analyses as follows: (1) initial asset transfer of in-kind goods like poultry or livestock, mentioned by the CHVs as a necessary step; (2) weekly stipends with consumption support to stabilise consumption; (3) hands-on training on how to care for assets, start and run a business based on the assets transferred; (4) training on and facilitation for savings and financial support to build assets and instil financial discipline; (5) healthcare provision and access and finally (6) social integration. These strategies were proposed by the CHVs to enhance economic empowerment and aligned with the UPG Model.ConclusionThese results provide a user-defined approach to identify and assess strategic needs of and approaches to CHVs’ socio-economic empowerment using the UPG model. This model was useful in mapping the findings of our qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower CHVs and enhance their retention in our setting.
Highlights
A significant shortage of healthcare workforce exists globally
Nyanja et al Hum Resour Health (2021) 19:104 qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower Community health volunteer (CHV) and enhance their retention in our setting
Shortage of skilled health workers in underserved areas is a key aspect of the growing human resource crisis in most low- and middle-income countries (LMICs) [1,2,3,4,5] and as a consequence the role of community health volunteers (CHVs) is increasingly important
Summary
A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare coverage, governments need to enhance their community-based health programmes. In Kenya, CHVs have been a vital part of primary health service delivery for decades bridging the communities health system gap and helping ameliorate Kenya’s shortage and inequitable distribution of health workforce [11]. Despite their vital contribution to healthcare service provision, lack of support, recognition, facilitation and incentives leads to high attrition rates in both voluntary and paid CHVs [1, 8, 11, 13]. High attrition rates among this cadre leads to gaps in the delivery of essential services, loss of opportunity to build on expertise and increasing transactional costs arising from recurrent recruitment and training [2, 11]
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