A comparative study of an NGO-sponsored CHW programme versus a ministry of health sponsored CHW programme in rural Kenya
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RESEARCH
Open Access
A comparative study of an NGO-sponsored CHW programme versus a ministry of health sponsored CHW programme in rural Kenya: a process evaluation Jackline O Aridi1*, Sarah A Chapman2, Margaret A Wagah3 and Joel Negin4
Abstract The varied performance of Community Health Worker (CHW) programmes in different contexts has highlighted the need for implementation of research that focuses on programme delivery issues. This paper presents the results of process evaluations conducted on two different models of CHW programme delivery in adjacent rural communities in in Gem District of Western Kenya. One model was implemented by the Millennium Villages Project (MVP), and the other model was implemented in partnership with the Ministry of Health (MoH) as part of Kenya’s National CHW programme.
Introduction Community Health Worker (CHW) programmes have been utilized globally as part of primary health care approaches for many decades [1]. In most developing countries these approaches were strengthened in the late 1970s after the Alma Ata conference in 1978 that aimed at increasing access to health care through the call for ‘health for all’ [2]. Several decades on, the performance of CHW programmes has met with mixed reviews. Cochrane reviews have provided evidence that establish the effectiveness of CHWs in certain key areas such as exclusive breastfeeding, increasing immunization uptake and fewer children suffering from fever, diarrhoea and pneumonia [3]. However, other evaluations establish that in certain settings CHWs have been unable to decrease mortality and have provided poor quality services that were not consistent enough to substantiate impact [1,4]. Clearly, while the use of CHWs has the potential to positively influence health outcomes of community members, there remain significant challenges in implementation particularly in national programmes when rolled out at scale [5].
* Correspondence: [email protected] 1 The Ford Family Program in Human Development Studies and Solidarity, University of Notre Dame, Nairobi, Kenya Full list of author information is available at the end of the article
With respect to challenges in implementation, a number of common barriers have been identified which include community-level factors such as health beliefs, geography and infrastructure as well as broader health system factors such as remuneration and supervision [6]. Irregular drug supply and inappropriate CHW recruitment have also been identified as factors that hinder implementation [7]. In other cases, there may be a strong local demand for curative services and not the health promotion services that CHWs routinely provide [8]. National-level CHW studies have identified four general problems: unrealistic expectations, poor initial planning, problems of sustainability and difficulty in maintaining quality [9,10]. Yet, despite these challenges, it is still widely acknowledged that some role for CHWs is needed particularly in poor and underserved rural populations [11-13]. Given such varied performa
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