Time savings – realized and potential – and fair compensation for community health workers in Kenyan health facilities: a mixed-methods approach

Human Resources for Health

Jennifer Cohn⁴  Mark Pauly²  David Holtzman¹  Laura D Sander³ 

[1] Baylor International Pediatrics AIDS Initiative, Maseru, Lesotho;University of Pennsylvania Wharton School, Philadelphia, PA, USA;Johns Hopkins Bloomberg School of Public Health, 1000 E. Eager Street, Baltimore, MD 21202, USA;Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

关键词: compensation;    Kenya;    community health workers;    task shifting;   

Others  :  1133702
DOI  :  10.1186/1478-4491-13-6

 received in 2014-09-08, accepted in 2015-01-13,  发布年份 2015

【 摘 要 】

Background

Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. This study describes tasks shifted from clinicians to CHWs in Kenya, places monetary valuations on CHWs’ efforts, and models effects of further task shifting on time demands of clinicians and CHWs.

Methods

Mixed methods were used for this study. Interviews were conducted with 28 CHWs and 19 clinicians in 17 health facilities throughout Kenya focusing on task shifting involving CHWs, time savings for clinicians as a result of task shifting, barriers and enabling factors to CHWs’ work, and appropriate CHW compensation. Twenty CHWs completed task diaries over a 14-day period to examine current CHW tasks and the amount of time spent performing them. A modeling exercise was conducted examining a current task-shifting example and another scenario in which additional task shifting to CHWs has occurred.

Results

CHWs worked an average of 5.3 hours per day and spent 36% of their time performing tasks shifted from clinicians. We estimated a monthly valuation of US$ 117 per CHW. The modeling exercise demonstrated that further task shifting would reduce the number of clinicians needed while maintaining clinic productivity by significantly increasing the number of CHWs.

Conclusions

CHWs are an important component of healthcare delivery in Kenya. Our monetary estimates of current CHW contributions provide starting points for further discussion, research and planning regarding CHW compensation and programs. Additional task shifting to CHWs may further offload overworked clinicians while maintaining overall productivity.

【 授权许可】

   
2015 Sander et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: Working together for health. In World health report 2006. Geneva: WHO; 2006. http://www.who.int/whr/2006/en/ webcite. Accessed 11 March 2011
• [2]World Health Organization: Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. 2008. http://www.who.int/healthsystems/TTR-TaskShifting.pdf webcite. Accessed 16 May 2011
• [3]Samb B, Celletti F, Holloway J, Van Damme W, De Cock KM, Dybul M: Rapid expansion of the health workforce in response to the HIV epidemic. N Engl J Med 2007, 357:2510-4.
• [4]Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al.: Human resources for health: overcoming the crisis. Lancet 2004, 364:1984-90.
• [5]Islam A, Wakai S, Ishikawa N, Chowdhury A, Vaughan J: Cost-effectiveness of community health workers in tuberculosis control in Bangladesh. Bull World Health Organ 2002, 80:445-50.
• [6]Nganda B, Wangombe J, Floyd K, Kangangi J: Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District Kenya. Int J Tuberc Lung Dis 2003, 7:S14-20.
• [7]Walker DG, Jan S: How do we determine whether community health workers are cost-effective? Some Core Methodological Issues. J Community Health 2005, 30:221-9.
• [8]Weidle PJ, Wamai N, Solberg P, Liechty C, Sendagala S, Were W, et al.: Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet 2006, 368:1587-94.
• [9]Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, et al.: Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia. BMC Health Serv Res 2009, 9:1-9. BioMed Central Full Text
• [10]Callaghan M, Ford N, Schneider H: A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health 2010, 8:1-9. BioMed Central Full Text
• [11]Bemelmans M, van den Akker T, Ford N, Philips M, Zachariah R, Harries A, et al.: Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care. Trop Med Int Heal 2010, 15:1413-20.
• [12]Selke HM, Kimaiyo S, Sidle JE, Vedanthan R, Tierney WM, Shen C, et al.: Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: clinical outcomes of a community-based program in Kenya. J Acquir Immune Defic Syndr 2010, 55:483-90.
• [13]Datiko D, Lindtjorn B: Cost and cost-effectiveness of smear-positive tuberculosis treatment by health extension workers in southern Ethiopia: a community randomized trial. PLoS One 2010, 5:e9158.
• [14]Mwai GW, Mburu G, Torpey K, Frost P, Ford N, Seeley J: Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2013, 16:1-14.
• [15]Perry H, Zulliger R: How effective are community health workers?. 2012. http://www.coregroup.org/storage/Program_Learning/Community_Health_Workers/review%20of%20chw%20effectiveness%20for%20mdgs-sept2012.pdf webcite. Accessed 26 January 2014
• [16]Republic of Kenya Ministry of Public Health and Sanitation: Report of the review of the implementation of the community health strategy. Kenya: Nairobi; 2009.
• [17]Partnership The United National Development Program Japan and GROOTS Kenya: Compensation for contribution report: a baseline study. Kenya: Nairobi; 2009.
• [18]Lehmann U, Sanders D: Community health workers: What do we know about them?. World Health Organization: Geneva, Switzerland; 2007. http://www.who.int/hrh/documents/community_health_workers.pdf webcite. Accessed 16 May 2011
• [19]Hermann K, Van Damme W, Pariyo GW, Schouten E, Assefa Y, Cirera A, et al.: Community health workers for ART in sub-Saharan Africa: learning from experience–capitalizing on new opportunities. Hum Resour Health 2009, 7:31. BioMed Central Full Text
• [20]Jaskiewicz W, Tulenko K: Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Hum Resour Health 2012, 10:38. BioMed Central Full Text
• [21]Republic of Kenya Ministry of Health: Taking the Kenya Essential Package for Health to the Community: A Strategy for the Delivery of Level One Services. Nairobi, Kenya: Republic of Kenya Ministry of Health; 2006. http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/community_strategy.pdf webcite. Accessed 17 May 2011
• [22]Mireku M, Kiruki M, McCollum R, Taegtmeyer M, de Koning K, Otiso L: Context Analysis: close-to-community health services providers in Kenya. 2014. http://www.reachoutconsortium.org/media/1837/kenyacontextanalysisjul2014compressed.pdf webcite. Accessed 30 November 2014
• [23]Republic of Kenya Ministry of Public Health and Sanitation: 8 March 2011). Policy shift on community strategy (Ref. No: MPHS/ADM/2/30 Vol.IV. Nairobi, Kenya; 2011.
• [24]Government of Kenya: Revised scheme of service for clinical officers. Nairobi, Kenya: Government of Kenya; 2010. http://clinicalofficerscouncil.org/resources/SCHEME_OF_SERVICES_FOR_CLINICAL_OFFICERS.pdf webcite. Accessed 30 November 2014
• [25]Mbindyo P, Blaauw D, English M: The role of Clinical Officers in the Kenyan health system: a question of perspective. Hum Resour Health 2013, 11:32. BioMed Central Full Text
• [26]Nursing Council of Kenya: Education Information: Approved Nursing Programmes. Nairobi County, Kenya; 2014. http://nckenya.com/edu/programmes/ webcite. Accessed 30 November 2014
• [27]Chankova S, Muchiri S, Kombe G: Health workforce attrition in the public sector in Kenya: a look at the reasons. Hum Resour Health 2009, 7:58. BioMed Central Full Text
• [28]World Health Organization: Global Atlas of the Health Workforce. Geneva, Switzerland: World Health Organization; 2010. http://apps.who.int/globalatlas/default.asp webcite. Accessed 13 April 2011
• [29]One Million Community Health Workers Campaign: Update from the field: Kenyan community health services works to establish national standards. New York, New York; 2014. http://1millionhealthworkers.org/2014/08/25/update-from-the-field-kenyan-community-health-services-works-to-establish-national-standards/ webcite. Accessed 30 November 2014
• [30]Government of Kenya and UNICEF: Evaluation report of the community health strategy implementation in Kenya. Nairobi, Kenya: Government of Kenya and UNICEF; 2010. http://www.unicef.org/evaldatabase/files/14_2010_HE_002_Community_Strategy_Evaluation_report_October_2010.pdf webcite. Accessed 30 November 2014
• [31]Greene JC, Caracelli VJ, Graham WF: Toward a conceptual framework for mixed-method evaluation designs. Educ Eval Policy Anal 1989, 11:255-74.
• [32]Columbia University Center for International Earth Science Information Network: Gridded population of the world. New York, New York; 2013. http://sedac.ciesin.columbia.edu/gpw/country.jsp?iso=KEN webcite. Accessed 14 May 2011
• [33]Kenya National Bureau of Statistics: Country stats. Nairobi, Kenya; 2015. http://www.knbs.or.ke/ webcite. Accessed 14 May 2011
• [34]Lassi ZS, Gometto G, Huicho L, Bhutta ZA: Quality of care provided by mid-level health workers: systematic review and meta-analysis. Bull World Health Organ 2013, 91:824-33. Doi:10.2471/BLT.13.118786
• [35]Chung J, O’Brien M, Price J, Shumbusho F, International AIDS Society: Quantification of physician-time saved in a task shifting pilot program in Rwanda. AIDS 2008 – XVII Int. Geneva, Switzerland: AIDS Conference; http://www.aids2008.org/Pag/Abstracts.aspx?SID=255&AID=6043 webcite. Accessed 16 May 2011
• [36]Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al.: Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 2010, 28:1-208.
• [37]Hongoro C, McPake B: How to bridge the gap in human resources for health. Lancet 2004, 364:1451-6.
• [38]Schneider H, Hlophe H, van Rensburg D: Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects. Health Policy Plan 2008, 23:179-87.
• [39]Philips M, Zachariah R, Venis S: Task shifting for antiretroviral treatment delivery in sub-Sahran Africa: not a panacea. Lancet 2008, 371:682-4.
• [40]Nkonki L, Cliff J, Sanders D: Lay health worker attrition: important but often ignored. Bull World Health Organ 2011, 89:919-23.
• [41]McCord GC, Liu A, Singh P: Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions. Bull World Health Organ 2013, 91:244-53B.