Upload
aldous-obrien
View
222
Download
1
Tags:
Embed Size (px)
Citation preview
Factors Influencing the Functionality and Sustainability of Community Units in Rural Kenya; The Case of
Makueni County
Karijo Evalin, Kampen Denise, Gitimu Anne, Oruko Happiness , Karijo Evalin, Kampen Denise, Gitimu Anne, Oruko Happiness , Ndunge Fidelina, Ogendo Ken, Ofware PeterNdunge Fidelina, Ogendo Ken, Ofware Peter
AMREF Kenya, Free University of Amsterdam, Kenya Ministry of HealthAMREF Kenya, Free University of Amsterdam, Kenya Ministry of Health
Outline of Presentation• Background
• Problem Statement
• Research Questions
• Methodology
• Results
• Conclusion
• Recommendations
Background• Community Health Worker programs – in line with the Alma Atta
declaration for Primary Health Care & vital for MDGs’ achievement
(WHO, 2010).
• Kenya – primary health care
institutionalized in 2006 through
the Community Strategy
(GoK, 2006)
• Benefits in improving community
knowledge on maternal health & child health (USAID, 2013)
April 18, 2023 3
Background
April 18, 2023 4
Structure of Community Strategy - Community Units
Problem Statement• Constraints of Community Units implementation (GoK, 2010):
i) Community Strategy budgetary commitment : 9% of health care funding
ii) Harmonizing different approaches of CU implementation
iii) Sustaining CUs after exit of development agencies
• Community Units (CUs) in Makueni, Kenya (GoK, 2013): 11 non-operational, 46 semi-functional, 16 functional
• Little comprehensive research on functionality & sustainability of CUs – most focus on CHW attrition only & not the actors of CU implementation in entirety
April 18, 2023 5
Research Questions1. What community level factors influence the functionality and sustainability of Community Units?
2. What factors of the Community Unit workforce cadre, influence the functionality & sustainability of Community Units?
3. What factors in the CU link health facility influence the functionality and sustainability of Community Units?
4. What factors from supporting development agencies, and the government influence the functionality and sustainability of Community Units?
April 18, 2023 6
Conceptual Framework(Adapted from CU functionality score-card (AMREF, 2013) & Implementation Science
(Schel, et al, 2013)
April 18, 2023 7
MA
KUEN
I CO
UN
TY, K
ENYA
COMMUNITY UNITS
Community Level
CU Workforce
Cadre
Link Health Facility
Government and
development agencies
Methodology• Study design:
-Qualitative exploratory study
• Purposive sampling
-Study population – 73 CUs
-Sample population – 4 CUs
• Data collection
-Semi-structured interview guides
-16 Focus Group Discussions - CHWs, CHC, community men & women
-15 Key Informant Interviews - CHEWs, SCHMT & development agencies
April 18, 2023 8
Sampling Technique
&8 V- 0 DNXHQL&RXQW\ . HQ\ D
&8 VLQH[ LVWHQFHIRU! \ HDUVWURVSHFW
&8 VHVWDEOLVKHGE\ GLIIHUHQWDJHQFLHVLQWKHVDP H\ HDU
&8 VHVWDEOLVKHG LQE\GLIIHUHQWDJHQFLHVLQ. LEZH] L0 ERRQL( DVWDQG. DWKRQ] ZHQL
MethodologyData management
• Transcription & Translationo Tape recording & transcription – Listen & Write softwareo Direct translation into English
• Validityo Spot checks for translation errors o Triangulation on stakeholder levels
• Semi-open coding o Coded with MaxQda10 softwareo Matrix grouping of codes per level o Most frequent factors and relationships were analyzedo Texts analyzed for inter-play of factors
April 18, 2023 9
Results1. Factors at community level
April 18, 2023 10
Functionality themes
Sustainability themes
ResultsFactors at community level
Underlying issues:
a) Community members’ awareness on CHWs & CHC role: CHWs well accepted for their direct contact with community members.
“They (CHWs) have been good advisers for women in the reproductive age, and more so who like giving birth at their homes. They are also advised on the importance of attending ANC clinics” [Community Women FGD]
b) Community participation in CU activities: Minimal involvement by community in CU financial initiatives & plans
c) Fulfillment of community members needs: desired provision of more medical supplies e.g drugs and aqua tabs, & desired meetings with CHWs
April 18, 2023 11
Results2. Factors of CU work-cadre
April 18, 2023 12
Functionality themes
Sustainability themes
ResultsFactors of CU work-cadre
Underlying issues:
a)CHWs expectation versus reality:
"I expected that if I remain active as a
community health worker I will be able
to get employed and work for my
children". [CHW FGD]
b) Required support versus actual support:
inadequate incentives & working aids hence diminished motivation
c) Workforce struggles:
Conflict between CHWs & CHC: CHWs deemed superior
•Other studies: WHO (2007) – complex factors are required for motivation & attrition including financial & intrinsic rewards
April 18, 2023 13
Results3. Factors of CU-Link Health Facility
April 18, 2023 14
Functionality themes
Sustainability themes
ResultsFactors of CU-Link Health Facility
Underlying issues:
a)CHEWs’ increased work-load
CU technical advisor cum health facility
staff responsibilities
b) Link health facility services
•Services at CU link facility beneficial to community. However low quality
of services due to including inadequate essential commodities & limited
hours of service delivery & staff shortage
April 18, 2023 15
Results4. Government and Development Agencies support
April 18, 2023 16
Functionality themes
Sustainability themes
ResultsGovernment and Development Agencies support
April 18, 2023 17
a) Incentives hampering sustainability:
Temporary solution for functionality if they cease abruptly
b) Implementing partner withdrawal/exit:
Inadequate exit strategies for sustainability are fatal for community units
c) Government limitations:
Government supervisory/management role lacking for CU workforce
•Other studies (USAID, 2013) – coordination of development agencies’ support vital for sustainability
Results
April 18, 2023 18
Themes with strongest Inter-relationThemes with strongest Inter-relation
ThemesThemes
Conclusion
April 18, 2023 19
• Most important themes: based on predominance, strongest relations & underlying issues:
MA
KUEN
I CO
UN
TY, K
ENYA
COMMUNITY UNITS
Community Level
CU Work-Cadre
CU Link Health Facility
Government –
coordination & resource allocation
RecommendationsFunctionality and Sustainability
In Kenya’s devolved system of governance – for CUs to have
sustainable impact on maternal and child health:
County Governments : resource allocation & technical oversight
to ensure:
-Organizational capacity: effective governance of CU, skilled &
motivated workforce, and adequate working aid
-Development agencies’ coordination & phase out strategy for
sustainability
-Community partnership & ownership in implementation
April 18, 2023 20
Acknowledgment• Research Investigators: Evalin Karijo, Denise Kampen, Anne
Gitimu, Happiness Oruko, Fidelina Ndunge, Ken Ogendo, Peter Ofware
• Comic Relief - UK: Project donor
• Makueni Health Management Teams: Kibwezi, Makueni, and Mbooni Sub-Counties
• AMREF Kenya Ag. Country Director: Dr. Meshack Ndirangu
• AMREF RABD Unit: Anne Murugi, Dr. Ojakaa
• AMREF ESRC for approval of Research
April 18, 2023 21