Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.

Beth Rachlis,Regina Kamene,Paula Braitstein,Juddy Wachira,Beatrice Koech,Becky Genberg,Violet Naanyu,Jackie Akinyi,Mark J Siedner

doi:10.1371/journal.pone.0149412

Abstract

Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN. Data was coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization and considering CHWs as a potential enabling resource. A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare providers participated. Participants identified several roles for CHWs including promoting primary care, encouraging testing, providing education and facilitating engagement in care. While various facilitating aspects of CHWs were uncovered, several barriers of CHW care were raised, including issues with training and confidentiality. Suggested resources to help CHWs improve their services were also described. Our findings suggest that CHWs can act as catalysts and role models by empowering members of their communities with increased knowledge and support.

Highlights

High healthcare costs, a lack of adequate infrastructure, and health worker shortages all decrease the ability of Low- and Middle-Income Countries (LMICs) to deliver primary healthcare services to their populations [1,2,3]
A total of 207 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or hypertension (n = 21); 24 caregivers; 10 community leaders; and 34 healthcare workers participated in the study
We explored the role of Community Health Workers (CHWs) generally, and in terms of facilitating engagement in care for chronic disease management in western Kenya

Summary

Introduction

A lack of adequate infrastructure, and health worker shortages all decrease the ability of Low- and Middle-Income Countries (LMICs) to deliver primary healthcare services to their populations [1,2,3]. In response to these health worker shortages, the World Health Organization (WHO) launched the “treat, train, retain” initiative in 2006 [6] in an effort to strengthen and expand the global health workforce. This included the development of more formal cadres of Community Health Workers (CHWs), defined as “members of, selected by, and answerable to the communities where they work; supported by the health system; and receiving less training than formally trained health workers” [7, 8]. CHWs deliver low cost primary healthcare services to the communities they serve [9]. The 2008 WHO report Primary Health care- More Than Ever, citing previous “failures and shortcomings” that have resulted in massive health inequities between and within countries, reinforced the important role of primary healthcare and CHWs in ensuring health for all [13]

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