Community Health Workers Volunteerism and Task-Shifting: Lessons from Malaria Control and Prevention Implementation Research in Malindi, Kenya.

Muia D, Kamau A, Kibe L
American Journal of Sociological Research. 2019;9

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Community health workers (CHWs) operating as volunteers are vital front-line health care workers. They are critical actors in enhancing access to universal health care. The 2006 WHO Report which focuses on human resources for health sees task-shifting as a key response to staff shortage. CHWs thus undertake delegated health care system service delivery at the community level and in most cases for no pay. This paper is drawn from a two years (2015 - 2017) TDR/WHO supported implementation research project which sought to enhance the role of CHWs in malaria prevention and control. The CHWs use community development methodologies to promote work which is otherwise bio-medical. Community engagement is employed not only as a method of passing on critical information on malaria prevention but also as a process of empowering the community to make decisions and to implement and manage change. The CHWs drawing from the Paulo Freire conscientisation process also leads communities to reflect and act on ways of controlling and preventing malaria. The paper also discusses the dilemma of working with CHWs as volunteers whom under task shifting provide services for which compensation could be offered. The study, using a descriptive survey design, collected data from twenty purposively selected CHWs who participated in the project. It found that CHWs are of relatively low socioeconomic status, with only 36.4% having completed primary school education. CHWS are involved in promoting general community health, immunization and sanitation; referring the sick to hospital; and malaria control activities. CHWs perceived their strength as lying in their training and the community recognition and appreciation of their work. CHWs were also aware of the empowerment process that took place in communities out of the community engagement process. While CHWs work as volunteers, they appeared to be keen on getting compensation (Mnyafulo) out of the project. The suggestion was that for sustainability and after the project phase out they could be motivated through some regular stipend as well as uniforms and certification for recognition purposes. This paper concludes that to the extent that task shifting is a reality given the shortage of health staff, policy measures need to be put in place to institutionalize CHWs and their work. This would also entail (and on ethical basis) ensuring some form of compensation for the crucial work done by CHWs in their community units. Continuing capacity building of CHWs also needs to be inbuilt in the county health system.