Table 2.
Management characteristics in the Community Health Worker Attrition Study, Kwale County, Kenya
| Characteristic | Community health workers who left (%) n=112 |
Community health workers who remained active (%) n=262 |
Total n=374 |
| Trained >4 weeks | |||
| No | 105 (30.5) | 239 (69.5) | 344 |
| Yes | 6 (23.1) | 20 (76.9) | 26 |
| Refresher training (≤1) | |||
| No | 54 (51.4) | 51 (48.6) | 105 |
| Yes | 52 (19.9) | 209 (80.1) | 261 |
| Supervision last 1 month | |||
| None | 28 (26.7) | 77 (73.3) | 105 |
| 1 time | 31 (21.8) | 111 (78.2) | 142 |
| 2 times | 23 (29.5) | 55 (70.5) | 78 |
| 3 times | 14 (60.9) | 9 (39.1) | 23 |
| >3 times | 15 (60.0) | 10 (39.1) | 25 |
| Supervisor | |||
| CHC members | 38 (25.7) | 110 (74.3) | 148 |
| CHEW | 61 (30.5) | 139 (69.5) | 200 |
| Others | 8 (40.0) | 12 (60.0) | 20 |
| Feel supervision adequate | |||
| No | 42 (30.2) | 97 (69.8) | 139 |
| Yes | 67 (29.3) | 162 (70.7) | 229 |
| Feedback from supervisor | |||
| No | 34 (40.0) | 51 (60.0) | 85 |
| Yes | 75 (26.6) | 208 (73.5) | 283 |
| Adequate support from supervisor | |||
| No | 37 (31.4) | 81 (68.6) | 118 |
| Yes | 71 (28.3) | 180 (71.7) | 251 |
| Received cash payments | |||
| No | 53 (27.0) | 143 (73.0) | 196 |
| Yes | 58 (32.8) | 119 (67.2) | 177 |
| Opinion on CHWs | |||
| Volunteer entirely | 50 (30.3) | 115 (69.7) | 165 |
| Get salary | 49 (32.9) | 100 (67.1) | 149 |
| Get stipend+other allowances |
12 (21.8) | 43 (78.2) | 55 |
| Who should select CHWs | |||
| Community | 87 (28.7) | 216 (71.3) | 303 |
| CHC, MOH, etc | 24 (34.8) | 45 (65.2) | 69 |
| Community appreciate work | |||
| No | 2 (50.0) | 2 (50.0) | 4 |
| Yes | 109 (29.6) | 259 (70.4) | 368 |
| Peer association membership | |||
| No | 12 (70.6) | 5 (29.4) | 17 |
| Yes | 99 (27.9) | 256 (72.1) | 355 |
| Receive support to enhance CHW work | |||
| No | 56 (32.6) | 116 (67.4) | 172 |
| Yes | 50 (26.2) | 141 (73.8) | 191 |
| Understand CHW roles | |||
| No | 4 (66.7) | 2 (33.3) | 6 |
| Yes | 107 (29.2) | 260 (70.8) | 367 |
| Performance ever evaluated | |||
| No | 21 (42.0) | 29 (58.0) | 50 |
| Yes | 90 (27.9) | 233 (72.1) | 323 |
| Days worked/month | |||
| 0–5 | 53 (26.8) | 145 (73.2) | 198 |
| 6–10 | 32 (32.3) | 67 (67.7) | 99 |
| >10 | 25 (33.3) | 50 (66.7) | 75 |
| Households visited last month | |||
| 0–5 | 15 (40.5) | 22 (59.5) | 37 |
| 6–15 | 34 (30.9) | 76 (69.1) | 110 |
| ≥16 | 60 (27.0) | 162 (73.0) | 222 |
| Forum/dialogues last month | |||
| None | 23 (34.9) | 43 (65.2) | 66 |
| Only 1 | 14 (16.7) | 70 (83.3) | 84 |
| 2–4 | 58 (32.8) | 119 (67.2) | 117 |
| ≥5 | 16 (35.6) | 29 (64.4) | 45 |
| Clients referred last month | |||
| None | 30 (31.9) | 64 (68.1) | 94 |
| Only 1 | 10 (23.3) | 33 (76.7) | 43 |
| 2–5 | 47 (29.2) | 114 (70.8) | 161 |
| ≥6 | 22 (31.9) | 47 (68.1) | 69 |
| Why became CHW | |||
| To assist community | 89 (29.0) | 218 (71.0) | 307 |
| Other reasons* | 20 (31.8) | 43 (68.3) | 63 |
| Constraints faced as CHW | |||
| Lack of supplies | 15 (26.3) | 42 (73.7) | 57 |
| Lack of transport | 27 (28.7) | 67 (71.3) | 94 |
| Lack of community support | 29 (24.2) | 91 (75.8) | 120 |
| Financial constraints | 32 (40.0) | 48 (60.0) | 80 |
| Others | 7 (38.9) | 11 (61.1) | 18 |
*Encouraged by community or family, for recognition in the community, for salary/stipend/tokens and to advance a career in health.
CHC, community health committee; CHEW, community health extension worker; CHW, community health worker; MOH, Ministry of Health.