Individual and contextual factors associated with community health workers' performance in Nyanza Province, Kenya: a multilevel analysis.

Yoshito Kawakatsu,Eric Were,Tomohiko Sugishita,Stephen Wakhule,Kennedy Oruenjo,Junya Tsutsui,Kennedy Kibosia,Sumihisa Honda

doi:10.1186/s12913-015-1117-4

Abstract

BackgroundSeveral African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. The objective of this research was to assess the CHWs’ performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the two levels, individual and supervisor/community.MethodsThis study conducted three surveys between August and September 2011 in Nyanza Province, Kenya. The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of that performance.ResultsThe significant factors associated with the CHWs’ performance were their marital status, educational level, the size of their household, their work experience, personal sanitation practice, number of supervisions received and the interaction between their supervisors’ better health knowledge and the number of supervisions.ConclusionA high quality of routine supervisions is one of the key interventions in sustaining a CHW’s performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational status, availability of supporters for household chores and good sanitation practices are all important in selecting CHWs who can maintain their high performance level.

Highlights

Several African and South Asian countries are currently investing in new cadres of community health workers as a major part of strategies aimed at reaching the Millennium Development Goals [1]
The average percentage of the number of households covered by community health workers (CHWs) in a community varied depending on the community
Around half of the community health extension workers (CHEWs) had worked less than 12 months and the mean of the community units (CUs) covered by each CHEW was 1.44

Summary

Introduction

Several African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. The density of the health workforce is inversely associated with maternal, infant and under-fives’ mortality [6], and is more than ten times higher in Europe and North America than in sub-Saharan Africa For this reason, the numbers of community health workers (CHWs) have been increasing recently, especially in low-income countries. Several African and South Asian countries are currently investing in new cadres of community health workers as a major part of strategies aimed at reaching the Millennium Development Goals [1]. The study in Kenya showed that one of the significant factors positively influencing the full vaccination of children was a better CHW performance at the community level, but the variability of their performance was reported [8]

Objectives

Methods

Results

Conclusion