The Role of Community Health Volunteers in Promoting Health Equity: Opportunities and Challenges in Accelerating Primary Healthcare Delivery in Kisumu County, Kenya

Abstract

Health equity is defined as the absence of systematic disparities in health and healthcare based on social advantage or disadvantage; it is a critical goal in global health. Community Health Workers/Volunteers (CHW/Vs) play a pivotal role in promoting health equity by delivering essential primary health services to underserved populations. This article focuses on the role of CHVs in promoting health equity in Kisumu County, Kenya, and explores the opportunities and challenges encountered in accelerating primary health care delivery. The study is informed by the health equity theory, which emphasizes fair and just access to health services for all populations. We utilized a qualitative research inquiry and applied an interpretive approach to understanding the role of CHVs in delivering community health services to community households as primary beneficiaries. Eighty-seven respondents were identified through purposive sampling, and data was collected through four focused group discussions (FGD) of 10 CHVs and 10 household representatives. Additionally, key informant interviews (KII) were conducted for 2 Community Unit (CU) members, 2 Community Health Extension Workers (CHEWs), and 3 community health officials drawn from the national, county, and sub-county levels, respectively. Both primary and secondary data was collected from purposively sampled households, community health workers and volunteers, and key persons engaged in running and/or providing community health care in the 7 sub-counties of Kisumu County. The data analysis was conducted using thematic inquiry to identify emerging patterns, and this was managed using NVivo software for coding and interpretation. The study's findings demonstrate that CHVs in Kisumu County impact service utilization and improve maternal health outcomes. They serve as early detectors of health issues, provide culturally appropriate care, and empower communities to actively participate in their health management. However, challenges such as shortages of CHW/Vs, limited resources, and gender norms hinder their effectiveness in delivering services. Opportunities for CHW/Vs in promoting health equity include increased access to healthcare, culturally appropriate care, prevention and health promotion, community empowerment, timely identification of health issues, strengthening the health system, flexibility, adaptability, community support networks, potential for research and innovation, and integration of services. CHVs in Kisumu County have significant opportunities to promote health equity by providing essential health services to underserved communities. Addressing challenges and improving the CHS model can unlock their full potential, contributing to the achievement of health equity for all residents in Kisumu County.