Application of the Ultra-Poverty Graduation Model in understanding community health volunteers’ preferences for socio-economic empowerment strategies to enhance retention: a qualitative study in Kilifi, Kenya

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Abstract

Background

A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare coverage, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area in Kenya.

Methods

This study adopted an exploratory qualitative approach. Using a semi-structured questionnaire, we conducted 10 Focus Group Discussions with the CHVs and 10 Key Informant Interviews with County and Sub-county Ministry of Health and Ministry of Agriculture officials including multi-lateral stakeholders’ representatives from two sub-counties in the area. Data were audio-recorded and transcribed verbatim and transcripts analysed in NVivo. Researcher triangulation supported the first round of analysis. Findings were mapped and interpreted using a theory-driven analysis based on the six-step Ultra-Poverty Graduation Model.

Results

We mapped the UPG Model’s six steps onto the results of our analyses as follows: (1) initial asset transfer of in-kind goods like poultry or livestock, mentioned by the CHVs as a necessary step; (2) weekly stipends with consumption support to stabilise consumption; (3) hands-on training on how to care for assets, start and run a business based on the assets transferred; (4) training on and facilitation for savings and financial support to build assets and instil financial discipline; (5) healthcare provision and access and finally (6) social integration. These strategies were proposed by the CHVs to enhance economic empowerment and aligned with the UPG Model.

Conclusion

These results provide a user-defined approach to identify and assess strategic needs of and approaches to CHVs’ socio-economic empowerment using the UPG model. This model was useful in mapping the findings of our qualitative study and in enhancing our understanding on how these needs can be addressed in order to economically empower CHVs and enhance their retention in our setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12960-021-00645-5.

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Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness.

Henry Perry, Rose Zulliger, Michael M Rogers (2014)

Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.

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Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

Brynne Gilmore, Eilish McAuliffe (2013)

Background Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. Methods A search strategy was developed according to the Evidence for Policy and Practice Information and Co-ordinating Centre’s (EPPI-Centre) guidelines and systematic searching of the following databases occurred between June 8 – 11th, 2012: CINAHL, Embase, Ovid Nursing Database, PubMed, Scopus, Web of Science and POPLINE. Google, Google Scholar and WHO search engines, as well as relevant systematic reviews and reference lists from included articles were also searched. Inclusion criteria were: i) Target beneficiaries should be pregnant or recently pregnant women and/or children under-5 and/or caregivers of children under-5; ii) Interventions were required to be preventive and delivered by Community Health Workers at the household level. No exclusion criteria were stipulated for comparisons/controls or outcomes. Study characteristics of included articles were extracted using a data sheet and a peer tested quality assessment. A narrative synthesis of included studies was compiled with articles being coded descriptively to synthesise results and draw conclusions. Results A total of 10,281 studies were initially identified and through the screening process a total of 17 articles detailing 19 studies were included in the review. Studies came from ten different countries and consisted of randomized controlled trials, cluster randomized controlled trials, before and after, case control and cross sectional studies. Overall quality of evidence was found to be moderate. Five main preventive intervention categories emerged: malaria prevention, health education, breastfeeding promotion, essential newborn care and psychosocial support. All categories showed some evidence for the effectiveness of Community Health Workers; however they were found to be especially effective in promoting mother-performed strategies (skin to skin care and exclusive breastfeeding). Conclusions Community Health Workers were shown to provide a range of preventive interventions for Maternal and Child Health in low- and middle-income countries with some evidence of effective strategies, though insufficient evidence is available to draw conclusions for most interventions and further research is needed.

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What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers

Kerry Scott, S. Beckham, Margaret Gross … (2018)

Objective To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. Methods We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. Findings We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. Conclusion Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential. Electronic supplementary material The online version of this article (10.1186/s12960-018-0304-x) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Njeri Nyanja:

ORCID: http://orcid.org/0000-0002-4831-8371

njeri.nyanja@aku.edu , alexxnyanja@gmail.com

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4491

Publication date (Electronic): 28 August 2021

Publication date PMC-release: 28 August 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 104

Affiliations

[1 ]GRID grid.470490.e, Department of Family Medicine, , Aga Khan University, ; Nairobi, Kenya

[2 ]GRID grid.470490.e, Centre of Excellence for Women and Child Health, , Aga Khan University, ; Nairobi, Kenya

[3 ]GRID grid.33058.3d, ISNI 0000 0001 0155 5938, Kenya Medical Research Institute, ; Nairobi, Kenya

[4 ]GRID grid.470490.e, Department of Population Health, , Aga Khan University, ; Nairobi, Kenya

[5 ]GRID grid.470490.e, Department of Obstetrics and Gynaecology, , Aga Khan University, ; Nairobi, Kenya

[6 ]GRID grid.5342.0, ISNI 0000 0001 2069 7798, Department of Public Health and Primary Care, International Centre for Reproductive Health, , Ghent University, ; Ghent, Belgium

Author information

Njeri Nyanja http://orcid.org/0000-0002-4831-8371

Article

Publisher ID: 645

DOI: 10.1186/s12960-021-00645-5

PMC ID: 8400398

PubMed ID: 34454506

SO-VID: 2b64d57a-d436-4695-95a5-56736a5036f9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 September 2020

Date accepted : 14 August 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100008627, global affairs canada;

Award ID: D-001983

Award Recipient : Marleen Temmerman

Funded by: FundRef http://dx.doi.org/10.13039/100009384, aga khan foundation canada;

Award ID: D-001983

Award Recipient : Marleen Temmerman

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: community health volunteers (chvs),kenya,socio-economic empowerment,ultra-poverty graduation model (upg),qualitative

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: community health volunteers (chvs), kenya, socio-economic empowerment, ultra-poverty graduation model (upg), qualitative

Application of the Ultra-Poverty Graduation Model in understanding community health volunteers’ preferences for socio-economic empowerment strategies to enhance retention: a qualitative study in Kilifi, Kenya

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Most cited references 27

Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness.

Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers

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