Abstract:
Background: Several African and South Asian countries are currently investing in new cadres of community health
workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one
review concluded that community health workers did not consistently provide services likely to have substantial
effects on health and that quality was usually poor. The objective of this research was to assess the CHWs’
performance in Western Kenya and describe determinants of that performance using a multilevel analysis of the
two levels, individual and supervisor/community.
Methods: This study conducted three surveys between August and September 2011 in Nyanza Province, Kenya.
The participants of the three surveys were all 1,788 active CHWs, all their supervisors, and 2,560 randomly selected
mothers who had children aged 12 to 23 months. CHW performance was generated by three indicators: reporting
rate, health knowledge and household coverage. Multilevel analysis was performed to describe the determinants of
that performance.
Results: The significant factors associated with the CHWs’ performance were their marital status, educational level,
the size of their household, their work experience, personal sanitation practice, number of supervisions received
and the interaction between their supervisors’ better health knowledge and the number of supervisions.
Conclusion: A high quality of routine supervisions is one of the key interventions in sustaining a CHW’s
performance. In addition, decreasing the dropout rate of CHWs is important both for sustaining their performance
and for avoiding the additional cost of replacing them. As for the selection criteria of new CHWs, good educational
status, availability of supporters for household chores and good sanitation practices are all important in selecting
CHWs who can maintain their high performance level
