Introduction
Methods
Research design
Study site, sampling and study population
CHVs | Gender | Female - 64 male - 17 |
CHV Work Experience | All CHVs had worked for over a year in their station | |
Age | CHVs interviewed ranged from 26 to 67 years of age | |
Educational level | All CHVs interviewed had at least primary level of education and were literate | |
Sub-county of residency | Total 81 participants interviewed; 57 were from Kaloleni and 23 were from Rabai | |
KII | KII1- Ministry of Health Sub-County officials | Kaloleni Sub-County—Ministry of Health official |
KII2 - Ministry of Health Sub-County officials | Rabai Sub-County Public health officer—also was representing county as a health promotion officer | |
KII3 - Ministry of Agriculture—Sub-County | Rabai—Agriculture extension officer—Sampled based on years of work experience in the community extension to provide insights on agriculture-based IGAs feasible | |
KII4- IGA Trainer—Civil Society Organization (CSO) | Rabai and Kaloleni Entrepreneurship/IGA trainer—sampled based on years of work experience in training Community-Based Organizations (CBOs) allocated IGAs and entrepreneurial funds by the Government | |
KII5- Stakeholder/CSO | Rabai Chairperson Upendo CBO group—sampled due to the role of leadership in the CBOs operations including IGAs | |
KII6- Stakeholder/CSO | Rabai Youth CBO—CBO leader—sampled based on experience having IGA for the CBO | |
KII7- Ministry of Health Sub-County official | Kaloleni Sub-County Community strategy focal Officer | |
KII8- Ministry of Agriculture—Sub-County | Kaloleni—Agriculture extension officer—sampled based on years of work experience in the community extension to provide insights on agriculture-based IGAs feasible |
Data collection and management
Data analysis and theoretical framework
Strategy implementation model (Okumus, 2003)
Results
Strategy development (need for new initiative [IGAs])
Need for IGAs initiative
Registration
A clear and binding constitution is a mandatory requirement for the group to be registered. The constitution must highlight the various activities they intend to do, rules and regulations governing the group, sources of income and regulations governing contributions, and sharing of responsibilities and funds.“One of the key things that will enable them to be funded, they must be under a certain umbrella and this case the umbrella will be a ‘community health volunteers’ group’, and then they are supposed to be registered in the social services so that at least they have the certificate of registration then they can use this certificate to seek support in what they want to do…… we also advise them to open a bank account” KII 8
“For them to be registered then they must have some constitution and under their constitution they must be having somewhere they are saying these are our activities, so they could be having several activities for example poultry rearing, rabbit keeping or maybe growing of tomatoes”. KII 8
Project selection
“Selection of income generating activities normally depends on the locality of the community unit…. I think what encourages them is, the culture of the community. For example, in Rabai, people love pleasure and ceremonies, and they conduct weddings a lot, and big burial ceremonies. So, you realize once somebody has those items (Tents, chairs and food warmers), rarely can he or she miss the market, then like urban centres like here of course the chicken project can do better because they have high demand in the hotels..... In the outskirts, of course, there are other projects that can do better, for example, they can sell water”. KII 1.,
I will be happy also if in this Kwale CU of ours if we get a sponsor who can make us improve, with the support for developing ourselves in the CU, If we get the tents and seats, and sufurias for making Biriyani or Pilau and plates it will be good because those utensils are usually required every day because people are dying every day they are needed, there are weddings they are needed, there is a party, they are required, so that will be good because they are needed and we will be able to stable to buy other things on our own and continue to develop our CU with other things. FGD1 R1
Choosing a project that has a chain of value addition was also preferred“You cannot start a boutique in Ngalibuni, that is weird, but in Ngalibuni you can start a grocery and it will pick. ….You can start a boutique in Mazeras, and it is will pick because it is a cosmopolitan area” KII 4
Crops that are plentiful during the rainy season and can be preserved for use during the dry season were also preferred“Let us think of a crop like cassava, cassava as a crop, has got various chains from the cuttings maybe you can make products for example make some crisps, maybe you want to make cassava flour, and so forth, maybe you want to make some cassava chips, we pack them and resell... and so forth. “ KII 3
Choice of a flexible project that an employee can run as they continue with their CHV work was also recommended:“They might look at a given crop which is in abundance during the rainy season. Maybe the vegetables or the local vegetables, they are in abundant, …. then they process, they just blanch or boil them under hot water and then they dry, they do the proper drying so that when the dry season comes and there are no vegetables, they will be selling the dried processed vegetables.” KII 6
However, another respondent disapproved of the idea of hiring an employee. He felt that employees could be trusted:“In case they are funded they get the posho mill and then they must pay someone there who will be running that posho mill, so that as they continue with the other activity then you find that this posho mill will be generating some activities, maybe on a monthly basis maybe they share the returns at the end of the month.” KII 4.
On the other hand, some respondents opted for capacity development on the IGAs that they are already involved in.“My suggestion is that we plan the duty roster so that everyone takes responsibility but if we say we employ someone, every time even the bible tells us, when one is on salary if he fails to get the salary, he can leave the chicken to die. But if I know those chickens are mine or I am benefiting from that chicken, I will not leave them. So, the idea of employing, I don’t support it, because I have experience of many things- I have kept cattle, I have kept chicken, I have employed people, and I have seen the effects of it.” FGD5 R1
“I am a painter even yesterday I was at St. Luke’s painting; I haven’t trained for that job, I have just learnt from my friends so that I am able to do that job of painting, but I haven’t trained. ….if I am taken to study it and then get a certificate so that if you find those people taking contracts when you show him that certificate that you are a painter, he will trust you and employ you.” FGD 1 –R1
“The work that earns me income is I grow vegetables like kales, amaranth, eggplant, radish and tomato. I farm a lot of tomatoes. That is what I use to support my family….. In that work, I usually use a lot of energy I don’t have a pump, I put water in the tanks, and I manually pour on the crops. If I could get a machine, it will be helpful.” FGD6 R1
Communal/group project
Groups enhance a sense of unity, cohesiveness, community and project continuity.“Nowadays it has become difficult to find someone who can fund individual persons so most of the individuals require a group certificate to be considered for funding.” KII 5 – CU Leader
“Individual projects for health volunteers will be breaking down the community because everybody will be independent, and… there will not be time for them to sit and discuss CHV issues because everybody will be concentrating on his or her own IGA.” KII 1.
It is easier for extension officers to supervise, support and manage group projects than individuals. It is also easy to keep track of the project’s progress.“If they work as a group, in case someone drops, some members will remain, and the project will continue and the CHVs will continue, to be together and move on because the project is not for an individual. We should be put together as Nyalani CU and start one joint project that is my idea”. FGD5 R1
It is easier to control group savings because of limited access to the funds than individual savings which is always tempting to spend.Okay, for my part, but for the CHVs everyone will feel good when running his or her own. But for me, I would wish the best is an entire IGA because you can be able to track, but individually, it is also a bit difficult. KII 2
In group projects, it will also be easier to delegate responsibilities and create time for CHV work and meetings than individual projects.“At this level, the chicken I have sold that money is mine, it is not ours, because sometimes what they do in a group in the income generating activities they channel it to the group. You might have ten chicken and maybe ther are ten of us, and because the chicken are in one place, we see them.” KII 8
However, a few CHVs and KII opted for individual projects.“If it will be an individual project, even on the meeting days, people will not be found, everyone will say I am busy, I don’t know what and what, but if there is a project that is as a group, we will do our activities as a group and distribute responsibilities” FGD5 R5
“For these income-generating activities to be successful, let this community of health workers be trained together on how to go about the production, but now when it comes to implementation of the project or the programme, let each one do it at his/her home or his farm but now when it comes to marketing then they can do collective marketing”…… it is not good to carry eggs in a single basket, maybe they might have a disease and wipe them …….also a thief might come and steal them,” KII 08,
“You know, sometime,s as human beings, we have a problem. I have dealt with groups for a long time. One time, our project was sponsored with sponsorship from America. Money was brought for building a structure for the chicken, and we built it, but for someone to come and check on the chicken in a day, it was impossible, and the project went down, so in my experience, the group things are problematic at times. That is my opinion, if it will be possible for everyone to be sponsored to rear their own chicken. If they are five, you can multiply them yourself, but there should be an officer who will be moving around, and when we meet in our monthly meeting, everyone should bring a report. That one will also help” FGD5 R1
Women were preferred more than men
More women than men were preferred to run the IGAs because people have witnessed their experience of successfully running group projects than men through chamas [self-help groups] and table banking and have successfully in uplifted their livelihoods. They also felt that women are more united hence it is easier to pull women together to do a joint project than men.“From my experience I will say female, female would be okay, because in most of our community health units the dominance of female health volunteers is almost at 65, 70%”. KII2
“Male community health volunteers might find challenges than women, women have done so well in groups, and they have been earning good money, so I think men will find more challenges than women …. Unlike men who sometimes don’t go far.” KII2.
“In fact, 80% of the projects that we are having in Kaloleni sub-county, females are more active” KII 3.
However, they felt that men could also be involved, especially at the planning stage, mainly to contribute ideas that can be incorporated into the project.“In fact, females become more successful easily compared to their male counterparts, so with females, they are good.” KII4
Need for capacity building
“I have seen quite a number of projects that have started but because of poor management issues, you find them somehow failing”. KII1.
“I would request if we would be given a chance to get trained, …. doing a project without the training might be difficult. …. I would request that we get the knowledge that can help us develop our group even to develop ourselves on advancing further”. FGD7 R8
“The first thing for me to get so much involved is to have enough education and enough awareness about this project. That is what will help me to take responsibility in doing this project. But if I am not informed well, I will not be able to run it well.” FGD5 R5
Members also proposed exchange programs as a way of learning new projects and management skills by visiting projects that are already in advanced stages.“The challenge is, because sponsor organizations come, they benchmark projects and exit soon… they don't leave at the point when this farmer is stable. …farmers are left at a point where they are having questions and wondering who to ask or where to go for help…. For example, I bring you dairy cattle, and before I confirm that the farmer has perfected running that project, the sponsor vanishes …..So, they keep on asking me so many questions that I cannot answer and blaming me for everything. As, the officer, I remain there being asked so, many questions and the donor has gone. He is nowhere to be seen….” KII 3
“I would like if AQCESS project would take usfrom Kwale CU somewhere to the other CUs so that we can go and observe how they are running their CU and learn a lot from them. We can learn a lot.” KII7 R7
Proposal for funding
“With a certificate of registration, they now have the right to seek financial support from anybody. Either from the government or from the partners.” KII 8
“Then out of the many proposed activities, they can write a proposal and then look for funding.” KII8.
Sources of funding
Monthly or weekly self-savings of certain agreed amounts were also proposed. The savings could be used as collateral to acquire loans from various government agencies (Uwezo fund, Youth enterprise fund or Women enterprise fund). Savings could also be raised from IGAs profits to be used in acquiring bigger loans to expand their project.“We have the government structures in place, we have Youth fund, we have Women enterprise fund, we have Uwezo fund, for all these counties, so, all these structures have money to support women and men, so if we can train our CHVs to be able to come up with a simple business plan then get funding from these government structures, they can easily get projects at the grass root level.” KII4
Savings through Merry-go-round (table banking) is not new to CHVs. It is an initiative already being practiced with the income they generate from the small IGAs that they are already involved in.“They will be contributing 50 bob, every month, this money acts as security to them, and then we don’t only depend on this money, we advise them to access the youth enterprise fund, there is women enterprise development fund, there is Uwezo Fund.” KII 4
Members also proposed to write a proposal to seek corporate sponsorships and donations and grants from charitable institutions and other well-wishers.“In this region, we depended on the brooms, we look for the leaves we make the brooms and sell. After selling them, as women we gather for a merry-go-round savings so that our income can be multiplied. ……My daily income is not enough to take the child to school and pay her school fees. If we do the merry-go-round, when it is my turn, it is maybe 6000, 7000. That is what I use to pay school fees for my child.” FGD 7-R8”
Members of parliament can also provide financial support for IGAs“Yes, we have our Rabai power station they have been so supportive, they have supported us with that, so I think they will be in a position to support the community health volunteers as well”. KII 5- CU Leader.
They also felt that Aga Khan is better positioned to support them more than any other institution (through projects similar to AQCESS- Access to Quality Care through Extending & Strengthening Health Systems))“If organizations would… support us with projects that can help us, we can also follow our MCA or our MP, through proposals so that we can get projects that can support CHVs” KII 05.
“I feel the one who can rescue us is AQCESS. … We have been around for a long time and the Councilors have come and left. We have not seen them holding our hands or sitting down as a group and telling us about development but AQCESS has started to open our eyes. So, this is the one I feel can hold our hand and rescue us”. FGD 7 R10
“The little we get from Aga Khan the 500 shillings, 300 shillings you can buy food for your children, your 200 shillings and 200 shillings from another one we put it in the account so that when we reach a point of doing the project, we would have reached far”. FGD6- R3
Constitution
Another control strategy that was proposed involved management of the collected income/profits. Collective savings that are shared at the end of the year were preferred:“Because of the property the chief is there to be a witness because the certificate is a binding document, and because they belong to the community, the area chief has to witness.” KII 7
“When we get there and the money is in the group, we take it and deposit it in the account, We put it there with a strategy maybe this money we will be withdrawing it in a year, we check how much of the profit we will have gotten, so that all of us we sit and decide on how to spend it.” KII 5- CHU Leader
“We will have something like a duty roster. For example, if I am on duty today, the next day is another who will take over, then like that until Sunday, maybe we need to be together, I must do my duty first, then I attend the CHV meeting/duty”. FGD 6 R7
Some participants proposed to come up with a duty roster so that everyone takes responsibility for running the project rather than hiring someone to take care of the projects:“I feel, for example, when we get that project, we will have to organize ourselves; we put up a duty roster so that if there are two people who will spend the day here and watch over the project activities when other are doing CHV work, the next day others so that we can see that our works are not affected but our project is also continuing. We can’t all come at once, then our work at home will not be done. We must have a plan that if ones come this day, then others come in another day so that the project can continue, and our activities continue also.” FGD5 R1
Leadership and management capacity building
There is need for accountability
“Once they see they see transparency and accountability then the next time, they will be motivated.” KII 08
Need for commitment from members
“There must also be some commitments because unless the officer is committed, then and try and mobilize the resources then we cannot move.” KII8
I would prefer to have a special committee selected to oversee the project’s activities alone. FGD 1 R5-
Networking/partnership
The Ministry of Agriculture is also another partner that was recommended for Agricultural IGAs.“We can be involved in supporting them to come up with business plans, …..because we have the government structures in place, we have Youth fund, we have Women fund, we have Uwezo fund, for all these counties, so, all these structures have money to support women and men, so if we can train our CHVs to be able to come up with a simple business plan then get funding from this government structures, they can easily get projects at the grass root level.” KII 4
“People from other sectors maybe like agriculture must advise these farmers which crops they can grow easily maybe vegetables and so forth.” KII 8
Other Partner institutions identified include: AQCESS project (Aga Khan).“We can have another person from outside, we will look for the agriculture officer or livestock to come and teach us so that we know what we will do when this project to the end of it.” FGD 5 R1