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Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, Peri-urban and rural agrarian)
Beverly Marion Ochieng and Dan CO Kaseje
Background: The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio demographic contexts, based type of tasks shifted.
The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them.
Methods: This was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies.
Key findings; Although the existing policy emphasizes demand creation, health promotion and disease prevention CHWs and consumers suggested the inclusion of some curative and research tasks.
Suggested tasks to be shifted to community health; The tasks suggested include: Home care for malaria and pneumonia, Acute respiratory infection (ARI), Epidemic recognition and reporting, Home based care for HIV/AIDS, Community based rehabilitation for chronically impaired (physical and mental), Arthritic care, Heart conditions, Community based Nutrition, Direct observation treatment for TB/AIDS, Home based care services for cancer and stroke patients. Household data collection, cleaning, analysis, interpretation and dissemination and conducting dialogue session
The emphasis for inclusion of curative care among CHWs tasks in nomadic areas was supported by the fact that this areas lag behind in improved geographic access to public health care. An analysis by Noor A.M. et al, (2009), demonstrated that the majority of Kenyan population is within the required 5KM distance from a health facility. There is evidence that CHWs are able to play an important role in health particularly for child survival and treatment of tuberculosis (TB) and HIV/AIDS (Chen 2004).
Sustainable motivational strategies for community health workers in task shifting
The study found out that motivational strategies ought to be consistent with tasks shifted to community level workers. These tasks include curative care which is currently not in the policy guidelines. The motivational strategies expressed by respondents in all the three sites included: supportive supervision, equitable allocation of resources, training, recognition, regulatory mechanisms and licensing. In the nomadic site, because of the problem of accessibility to services, due to distance, population movement and scarcity of health providers, suggested tasks shifted to community workers included curative care. Therefore their motivation strategies emphasized recognition, regulatory mechanisms, licensing and resources for the curative tasks. In the peri-urban site, the community health workers tended to have higher levels of education than the other two sites. They tended to be more interested in career development. Their motivation strategies needed to include competencies that they would be able to sell to their consumers, understandable given the harsh economic realities in urban slums.
Conclusions and recommendations The implication of these findings is the need to adapt motivation strategies to local contexts, considering differences in accessibility, disparities in resource allocation, and socio-cultural characteristics. Needs and demands of contexts are different and appropriate strategies need to be context specific to ensure quality service provision.