PROFILING THE PERFORMANCE OF COMMUNITY HEALTH VOLUNTEERS IN HEALTH SERVICE DELIVERY DURING THE COVID-19 PANDEMIC IN NAKURU COUNTY

Abstract

In response to the global shortage of healthcare workers, including Kenya, the World Health Organization (WHO) recommended utilizing Community Health Workers (CHWs), known as Community Health Volunteers (CHVs) in Kenya, to provide basic health services. This study aimed to assess the performance of CHVs in routine community health services in Nakuru County during the COVID-19 pandemic, evaluating their preparedness and challenges faced. The study employed concurrent triangulation mixed method research design, sampling 262 CHVs and 12 key informants. Data was collected from the Kenya Health Information System (KHIS), through in-depth interviews and through structured questionnaires. Descriptive statistics was used to analyze quantitative data while thematic analysis was applied to collected qualitative data. The study enrolled 262 CHVs, with a notable gender imbalance where 76.3% were females, and only 23.7% were males. The age distribution among CHVs was varied, with a majority falling within the 40-59 age range, comprising 65.6% of the total participants. The majority of CHVs were married (63.7%) and had completed secondary education (45.8%). A significant proportion of CHVs were engaged in business (47.8%) or farming (24.8%). Nearly all CHVs (98.9%) had volunteered for more than five years. A considerable number had completed technical training modules (62.6%). CHVs generally rated their performance as good both before and during the COVID-19 pandemic, albeit with slight agreement between the two periods (κ = 0.061). CHVs demonstrated resilience and adaptability during the pandemic, expanding their services to include COVID-19 responseactivities such as contact tracing. Despite initial disruptions, CHVs resumed their duties shortly after. The study highlights a significant delay in the preparedness of Community Health Volunteers (CHVs) for service delivery during the COVID-19 pandemic. CHVs faced various challenges in service delivery, including logistical constraints, lack of clear communication channels, and organizational shortcomings. Psychosocial challenges included fear of infection, stress, exhaustion and social isolation. The lack of frequent psychosocial support and counseling compounded the emotional toll on CHVs, leading to burnout and mental health issues. In conclusion, CHVs performed relatively betterduring the pandemic but there was a delay in terms of preparedness and notable challenges faced during service delivery. The study recommends, targeted recruitment of male volunteers, mentorship for younger recruits, continuous education for all CHVs, integrating pandemic preparedness into training, increased stakeholder investment, and comprehensive psychosocial support programs for CHVs.