“We are their eyes and ears here on the ground, yet they do not appreciate us”- Factors influencing the performance of Kenyan community health volunteers working in urban informal settlements

Abstract

AbstractCommunity Health Volunteers (CHVs) play a crucial role in linking the community with the formal health system, particularly in low- and middle-income countries. Studies in Kenya have focused on the implementation of the Kenya Community Health Strategy (CHS) in rural, nomadic, and peri-urban areas; with limited information on the factors that influence CHV performance in urban informal settlements. This study therefore explored factors that influence CHV performance in urban informal settlements within Nairobi Kenya and ways in which CHVs can be supported to enhance their wellbeing and strengthen community strategies. The study was undertaken in two urban informal settlements within Nairobi County. Thirteen focus group discussions (total of 123 participants) and three key informant interviews were conducted with a range of respondents. Various topics covering the design of the Community Health Strategy (CHS) and broader contextual factors that affect CHVs’ performance, were discussed and the data analysed using a framework analysis approach. The key programme design factors identified as influencing the performance of CHVs working in urban informal setting included: CHV recruitment; training; the availability of supplies and resources; and the remuneration of CHVs. Health system factors that influenced CHVs performance included: nature of relationship between healthcare workers at local referral facilities and community members; the availability of services and perceived corruption at the referral facilities; and CHV referral outside of the local health facility. Whereas the broader contextual factors that affected CHV performance at the community level included: demand for material or financial support; perceived corruption in community programmes; and neighbourhood insecurity. These findings suggest that like other CHVs working in both the rural and peri-urban settings, CHVs working in urban informal settlements in Kenya face a myriad of challenges that impact on their wellbeing and work performance. Therefore, to enhance CHVs’ well-being and improve their performance, the following should be considered: adequate and timely remuneration for CHVs, appropriate holistic training, adequate supportive supervision, and ensuring a satisfactory supply of resources and supplies. Additionally, at the health facility level, healthcare workers should be trained on appropriate and respectful relations with both the community and the CHVs, clarity of roles and scope of work, ensure availability of services, and safeguard against corrupt practices in public health facilities. Lastly, there is a need for improved and adequate security measures at the community level, to ensure safety of CHVs as they undertake their roles.