The Role of Income Generating Activities in Sustainable Retention of Community Health Volunteers in Primary Health-Care Service Provision in Bungoma County, Kenya

Abstract

The role of community health volunteers (CHVs) in provision of primary health-care (PHC) has been widely acclaimed as poignant. CHVs help not only in addressing shortage in trained health workers but also in improving access to health services. Several studies have been done on how to motivate and retain CHVs. However, a detailed study focused on income generating activities (IGAs) had not been done. In Kenya, devolution was embraced in 2010 and there is a drive toward community owned development processes. Thus, in each county, there are efforts for community engagement in provision of health-care services. However, due to budgetary constraints, the CHVs program is not adequately financed. To sustain the program, IGAs are encouraged and supported. The objective of the study was to evaluate the contribution of IGAs run by CHVs toward their sustainable retention in PHC service provision. The study design was descriptive cross- sectional study design. Cluster samplings, followed by systematic sampling methods, were adopted to obtain a randomized study sample. Fisher’s formula was used to obtain the required sample size of 222 from the current 2010 CHVs and 222 from the former 990 CHVs. Semi-structured questionnaires were used to collect both quantitative and qualitative data from current and former CHVs. Other data collection instruments for qualitative data were key informant interview guide for the CHVs’ supervisors; focus group discussion guide for current and former CHVs who were identified from existing records. Descriptive data were summarized through calculating and tendencies determined through the mean and the standard deviation. To explore relationship between variables, Chi-square test was done. This study established that stipends payment is a major factor affecting retention of CHVs in Bungoma County. The stipends paid were very low (inadequate), are paid irregularly, were not commensurate with the work load, and thus were not satisfactory to the CHVs. This enhanced the need for IGAs as a strategy for retention of CHVs in the PHC. The CHVs appreciated the need for an IGA in the Community Units (CUs). The popular IGAs in the CUs included table banking, poultry farming, dairy farming, horticulture farming, retail business, brick making, and goats rearing. Most IGA projects were not effective in contributing to retention of CHVs in PHC due to not only lack of enough capital for scaling up but also lack of proper management due to lack of training in business management and to group dynamics management.