Background
Methods
Study design
Study setting
Study population and sampling
1 | GENDER | • Female CHVs interviewed were 64 • Males CHVs interviewed were 17 |
2 | EXPERIENCE | • All CHVs had worked for more than one year. |
3 | AGE | • CHVs interviewed ranged from 26 to 67 years old |
4 | EDUCATION LEVELS | • All CHVs interviewed had attained primary level of education and could write and read |
5 | RESIDENCY | • We interviewed 81 participants of which 57 were from Kaloleni and 23 were from Rabai sub-counties |
Participant | Justification |
---|---|
Ministry of health sub-county officials N = 2 | We interviewed Kaloleni and Rabai sub-county ministry of health officials to provide views on policies and future plans on CHVs sustainability. We also wanted to understand what they know and what strategies and measures are in place to enhance the sustainability of the work of CHVs |
Ministry of Agriculture-Sub County N = 2 | Considering that the people in Kilifi area are subsistence farmers, we interviewed agricultural extension officer from Rabai and Kaloleni with specific experience in community extension to provide insights on agriculture-based IGAs appropriate for the Kilifi ecology. |
Income Generating Activity Trainer (IGA] – CBO N = 2 | We interviewed IGA from both Kaloleni and Rabai who were conversant with training community based organisation on entrepreneurial activities funded by the government. We hoped that they would share their experience on the potential opportunities and challenges. |
Stakeholder/CBO | The chairperson of a local CBO group –Upendo in Rabai was interviewed due to his distinct role in local CBOs as well as promoting IGAs. |
Stakeholder/CBO | A CBO youth leader in Rabai was interviewed based on his experience working with the youth on IGAs. |
Data collection
Data management and analysis
Findings
Codes | Categories | Themes | |
---|---|---|---|
A | -We are volunteers -CHV work conflicts with my informal business -CHV work conflicts with childcare; I can’t pay for childcare -I close my business to do CHV work -I can’t do CHV work with full-time job -It is difficult to attend social functions; -CHV work conflicts with household chores | -Lack of incentives -Conflicting chores -Lack of adequate time to do CHV work -Planning and time management | Effectiveness of CHVs’ work hampered by social-economic factors Context-specific challenges |
B | -We have no work plans -Unplanned meetings -CHV have no certification | -Poor coordination -Poor planning -Lack of training | Lack of training and daily work plans |
C | -People don’t understand who we are -People don’t understand what we do -We need labelled badges; we need labelled T-shirts -we have nothing to show that we are CHVs | -Need for identity -Pride of being a CHV -Recognition -A sense of belonging -Lack of identity and insecurity; identity can lead to trust | Identity/identification and trust |
D | -We prefer to buy chairs, tents and cutlery to use during weddings and funerals -high demand for chairs during weddings -high demand for chairs during funerals; chairs and tents needed for weddings and funerals -we have many weddings -hiring chairs and tents is a sustainable IGA; -chicken-rearing; kitchen gardens | -Events management; contextually supported activities (hiring of chairs and tents) -Farming, poultry-keeping | Income generating activities more likely to enhance retention among CHVs in Kaloleni and Rabai sub-counties -Hiring of tents, chairs and cutlery widely preferred and supported by contextual factors, e.g., high demand during weddings and funerals • Some places suitable for chicken-rearing |
Part A: challenges faced by CHVs in Rabai and Kaloleni
The challenge that I experience sometimes is because I need to be in a seminar and at the same time it is time to farm and remove weeds from maize. Now you find that you come here [doing CHV work] a whole week and you miss on the other side[Farming] FGD 1–RABAI
In rural Kaloleni and Rabai, most people run small informal businesses that are competitive and requires them to open their business premises throughout the day. In addition, employing someone to manage these businesses is expensive. CHVs with small informal businesses find it challenging to balance operating their businesses daily with community health promotion work.I am someone who sells Lesos [local clothes business]. There could be a date that is set for us to hand in the report [community health report] and maybe there is an activity that has come up that involves death [participation in community funerals]… Now you have to plan yourself—do I take the report [community health report] or go for the sale activity[local clothes business]? So, now if you take the report, there will be no business for you on the other side, I will have missed my customers. FGD 5–KALOLENI
I am required to be at my business and at the same time I need to be offering community service in connection with these health issues. Often, I have to look for someone to manage my business so [that] I can continue with these health care activities. FGD 1–RABAI
You are supposed to move around, maybe you have opened your business [and] you have to close it. … When you close it, the buyers come, they find you closed it, they go away. FGD 5–KALOLENI
The arrangement, coordination and planning of CHVs work make it difficult for members to take formal work. CHVs who managed to get casual jobs found it difficult to continue with their workFor now, I have a grandchild whom I am taking care of. My challenge is, I have to look for someone [to] leave my grandchild with before I can go to the community. Sometimes I leave her [childcare] and tell her, ‘I will give you anything that I get [payment]. Or sometimes when I am called for a seminar and I leave the same person [child care] with my grandchild, she also hopes to get something [to be paid]. FGD 4–RABAI
So, the challenge I get from my individual work and the CHV is that, maybe I leave here and go to Mariakani (town), I get a contractor [employer] …, he contracts me for 3 weeks, that means no CHV work as I will be there with the contractor who tells me to finish this work....and here [at the same time] the reporting time [for community health report] has reached. ..this is a challenge. FGD 9–KALOLENI
Okay I think it will be best if these CHVs can undergo thorough training first to enhance whatever they have, the information they have. Secondly, they could make proper work plans which could be financed to do the outreaches. KII–Community Based Youth Leader
In order for them to be effective, they must be properly facilitated other than that their number in a given centre must at least be a good number. Then you find in those health centres maybe they have one or two CHVs going on a shift. KII, Extension officer
So, I understand that they are trained but the only problem that those people [CHVs] are lacking is the certification. KII, Ministry of Agricultural representative
There is the economic challenge … now they keep questioning about what do they get in return after that, after doing that … since it is something voluntary. KII –Community Leader
The challenges that I am experiencing, for example, I do small business, I have made my Mahamri [local cakes] in the morning [to sell] and then I find out there is an impromptu meeting for the CHVs. I have to leave my things [business]. FGD 2–RABAI
Like today, I was to plant my tomatoes, I was to start at 2 o’clock, to dig the holes, put the manure at 5 o’clock in the holes, but that was impossible. I left it and came here at 12 o’clock until now I am here FGD 6–KALOLENI
My potato frying business [is] in the evening or making porridge in the morning. … If I am needed somewhere, my business has to close. …those potatoes usually get spoilt, they won’t find another person to sell them. FGD 6–KALOLENI
If we as community health volunteers, we can be recognized as providing health in the community, we can get a badge, t-shirt so we get in the community they know these are the health volunteers, because there are places when we get there we are despised, because we go just with our clothes as usual and then if you tell them to dig a toilet [pit latrine] they tell you go tell the doctor who sent you to come and dig that toilet [pit latrine] for them. But if we have the approvals[a badge and uniforms], …they will give us the respect and even our work will continue on well. FGD 2–RABAI
We would like to have uniform...we have our uniforms, we have our bags…then people will respect us, they will say these women are working at the hospital. FGD 6–KALOLENI
Part B: possible income-generating activities
If we were given an opportunity to choose the projects that we would like to develop later, we would like to get tents, cooking pots, plates, the cups considering that there are seasons where activities become more like weddings, funerals and stuff like these are widely used, so I feel we can earn money for the development of our [CHV] group …. FGD 1–RABAI
I feel the chair project together with the tents and the food trays, it [is] a project that can lift us up quickly because there are many activities and those things are hired out and are used let’s say in every week they are hired out and used, especially these tents and plates and these chairs. So, I feel that one can lift us up quickly. FGD 3–KALOLENI
I would also like to have land that we could till as a community unit and then just be helped with the seeds and fertilizers, so we can strengthen the farming and we can benefit from it. FGD 2–RABAI
Participants talked of the need to get a financial sponsor to help them in achieving their aspirations of starting farming projects.For our case, maybe let us think of a crop like cassava. Cassava is a crop, isn’t it? It has got various chains from the cuttings maybe you want to make products, make some crisps, maybe you want to make cassava flour, and so forth. KII–Extension officer
I would want chicken-rearing project, the ones that can produce eggs. I would like to have small business like rearing chickens for their meat and cows for milk. …but as I said if I get a sponsor to add for me so that they are many and also, if its food is available, that can be important to me. FGD 3–KALOLENI
In this section we have shown that community health volunteerism in rural Kilifi is not sustainable due to the interplay between individual and systemic influences. To minimise the rate of attrition, data shows CHVs desire to build on the already existing local activities such as farming and events management to generate income.The chicken-rearing is of two kinds or three kinds. There is farming for organic chicken for meat and eggs. So, I would like to say if we get the sponsor, we get the [chicken] rearing for meat, which is four weeks [grows in 4 weeks], and you sell them, and we also get [chicken] for the eggs. Then later we rear the organic ones because the organic ones also have good market. FGD 5–KALOLENI